Which TB interventions give the biggest health and economic gains?

Tuberculosis remains a leading infectious killer in many parts of the world, and governments and funders face hard choices about which tools to support. To help guide those choices, Rein M G J Houben and colleagues used a modelling approach to compare the likely population-level effects and costs of seven different TB interventions. The team calibrated a deterministic TB model to match epidemiological indicators in three very different settings: Brazil, India and South Africa. They tested a package of interventions covering prevention, screening and diagnosis, and treatment, and included two setting-specific measures: TB screening in prisons in Brazil and nutritional supplementation in India. To make fair comparisons they standardised how interventions would expand in the future (scale-up between 2025 and 2030), assumed the same high coverage (80% of each target population), and applied published efficacy estimates to project impact. The study then produced comparable estimates of both health impact and cost-effectiveness out to 2050, so policy makers can see which options might avert the most disease for the money available.

Using their calibrated model the researchers estimated both epidemiological outcomes and incremental cost-effectiveness ratios (ICERs), reported as costs per disability-adjusted life year (DALY) averted by 2050. Three interventions were predicted to prevent more than 10% of incident TB cases by 2050: vaccination (median reduction 15–28% across the three countries), symptom-agnostic community-wide screening (32–38%) and screening in prisons (23%). Other measures had smaller effects: shortened drug-susceptible treatment produced essentially 0% reduction in incidence, while nutritional supplementation in India produced about a 5% reduction. Costs and ICERs varied widely by intervention and setting. Shortened drug-resistant treatment was judged cost-saving across settings. The next-lowest ICERs were for prison screening in Brazil (72 USD/DALY) and nutritional supplementation in India (167 USD/DALY). Within each country, low-cost community-wide screening and TB vaccine campaigns had lower USD/DALY than TB preventive treatment, according to the model.

The study’s bottom line is that interventions with meaningful epidemiological impact can also be cost-effective, but only if they reach beyond people who already seek care at clinics or their household contacts. In other words, targeting broader populations — through community-wide screening, vaccination campaigns or focused settings like prisons — is where the biggest returns are likely to lie. The authors further note that realizing this potential will require shifts in funding priorities, policy decisions and product development to support interventions that operate outside the traditional clinic-focused model. By standardising assumptions about scale-up (2025–2030), coverage (80%), and using published efficacy data, the modelling offers a consistent comparison across very different country contexts, highlighting where investments might best reduce TB incidence and yield good value for money to 2050.