Tuberculosis in the Western Pacific Region: Estimating the burden of disease and return on investment 2020–2030 in four countries

Estill, Janne, Islam, Tauhid, Houben, Rein M.G.J., Rudman, Jamie, Ragonnet, Romain, McBryde, Emma S., Trauer, James M., Orel, Erol, Nguyen, Anh Tuan, Rahevar, Kalpeshsinh, Morishita, Fukushi, Oh, Kyung Hyun, Raviglione, Mario C., and Keiser, Olivia (2021) Tuberculosis in the Western Pacific Region: Estimating the burden of disease and return on investment 2020–2030 in four countries. The Lancet Regional Health - Western Pacific, 11. 100147.

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Background: We aimed to estimate the disease burden of Tuberculosis (TB) and return on investment of TB care in selected high-burden countries of the Western Pacific Region (WPR) until 2030.

Methods: We projected the TB epidemic in Viet Nam and Lao People's Democratic Republic (PDR) 2020–2030 using a mathematical model under various scenarios: counterfactual (no TB care); baseline (TB care continues at current levels); and 12 different diagnosis and treatment interventions. We retrieved previous modeling results for China and the Philippines. We pooled the new and existing information on incidence and deaths in the four countries, covering >80% of the TB burden in WPR. We estimated the return on investment of TB care and interventions in Viet Nam and Lao PDR using a Solow model.

Findings: In the baseline scenario, TB incidence in the four countries decreased from 97•0/100,000/year (2019) to 90•1/100,000/year (2030), and TB deaths from 83,300/year (2019) to 71,100/year (2030). Active case finding (ACF) strategies (screening people not seeking care for respiratory symptoms) were the most effective single interventions. Return on investment (2020–2030) for TB care in Viet Nam and Lao PDR ranged US$4-US$49/dollar spent; additional interventions brought up to US$2•7/dollar spent.

Interpretation: In the modeled countries, TB incidence will only modestly decrease without additional interventions. Interventions that include ACF can reduce TB burden but achieving the End TB incidence and mortality targets will be difficult without new transformational tools (e.g. vaccine, new diagnostic tools, shorter treatment). However, TB care, even at its current level, can bring a multiple-fold return on investment.

Item ID: 70361
Item Type: Article (Research - C1)
ISSN: 2666-6065
Keywords: Health economics, Mathematical model, Return on investment, Tuberculosis, Western Pacific Region
Copyright Information: © 2021 World Health Organization; licensee Elsevier. This is an open access article under the CC BY-NC-ND IGO license (
Date Deposited: 26 Apr 2022 02:03
FoR Codes: 49 MATHEMATICAL SCIENCES > 4901 Applied mathematics > 490102 Biological mathematics @ 30%
42 HEALTH SCIENCES > 4202 Epidemiology > 420205 Epidemiological modelling @ 70%
SEO Codes: 20 HEALTH > 2004 Public health (excl. specific population health) > 200404 Disease distribution and transmission (incl. surveillance and response) @ 80%
20 HEALTH > 2002 Evaluation of health and support services > 200205 Health policy evaluation @ 20%
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