Estimating the Epidemiological and Economic Impact of Providing Nutritional Care for Tuberculosis-Affected Households Across India

Abstract

Background: Approximately 20% of global tuberculosis (TB) incidence is attributable to undernutrition, increasing to more than a third in India. Targeting nutritional interventions to TB affected households is a policy priority, but understanding of epidemiological and economic impact is limited. 

Methods: We developed a transmission model of TB with explicit body mass index strata linked to disease progression and treatment outcomes. We used results from a recent trial of nutritional support to people initiating TB treatment and their households to inform estimates of impact and costs. 

Findings: Compared to a baseline with no nutritional intervention, at 50% coverage of adults on TB treatment (~23% of incident TB) and their households, providing nutritional support could prevent 361,200 (318,000–437,700) TB deaths and 880,700 (802,700-974,900) disease episodes over 2023-2035. This would be equivalent to averting approximately one in 20 (4.2%–5.5%) TB deaths and over one in 50 (2.1%–2.4%) TB episodes. The additional health system cost would be $1,349 million (1,221–1,492 million), with an incremental cost-effectiveness ratio of $167 (147-187) per disability-adjusted life year averted. To prevent one TB death or episode, a median 24.4 and 10.0 households needed to receive nutritional support, respectively. If 80% coverage (37% of incident TB) was reached, over one in 14 deaths and one in 30 episodes could be averted, with a total incremental cost of $2,139 million. 

Interpretation: A nutritional intervention for TB-affected households could avert a substantial amount of TB disease and death in India, and on TB-specific benefits alone would be highly likely to be cost-effective. 

Funding: This work was unfunded.

Declaration of Interest: We declare no competing interests.

Keywords: Food, Body Mass Index, Undernourished, Underweight, Supplement