Modeling the health and macroeconomic burdens of TB in India from 2021 to 2040

A new study in PLOS Medicine estimates the health and macroeconomic burdens of tuberculosis (TB) over the coming decades in India, and the macroeconomic return to investment in TB treatment in India. Existing assessments of the economic impact of TB do not capture the impacts on productivity and economic growth or the pathways by which epidemiology, demography, and the economy interact. Researchers developed a fully integrated dynamic macroeconomic-health-demographic simulation model for India, the country with the largest national TB burden worldwide.

The findings showed that over 2021 to 2040, the health and macroeconomic burdens of TB in India will include over 62.4m incident cases, 8.1m TB-related deaths and a cumulative gross domestic product (GDP) loss of US$146.4bn. Low-income households will bear larger health and relative economic burdens while larger absolute economic burdens will fall on high-income households. Achieving the World Health Organisation’s End TB target of 90% case detection could reduce clinical and demographic disease burdens by 75% to 89% and reduce the macroeconomic burden by US$120.2bn. Developing a 95% effective pan-TB treatment regimen would reduce the same burdens by 25% to 31% and US$35.3bn, respectively, while less effective but immediately achievable scaling-up of existing treatment regimens would reduce burdens by 20% to 25% and US$28.4bn, respectively. The Stop TB partnership previously estimated that less than half of the targeted funding of $2 billion per year, just $0.9 billion, was invested globally in the development of new TB diagnostics, drugs, and vaccines in 2020.

What do these findings mean?

• In spite of decade-long pursuits of strategies to end TB, the health and economic disease burdens of TB remain very high in India.
• Even our least effective, but most rapidly achievable revised TB treatment regimen has the potential to generate US$28bn in GDP gains, and thereby allow for strongly increased investment in TB control in India, which could reduce the suffering of TB patients while maintaining acceptable provision of resourcing elsewhere in the Indian economy. The potential gains of increasing case detection rates and implementing improved TB treatment regimens are substantial, but they hinge on both the feasibility and timeframe over which they can be achieved in practice.
• When developing this complex integrated model, it was necessary to simplify or limit the epidemiological aspect. We do not, therefore model drug susceptible and multidrug resistant (MDR) cases separately, neither do we separate public/private health care provision. However, these limitations could be addressed in future.

Thumbnail image credit: Shutterstock / Creative Krish