How much does it cost to treat a case of TB? The Global Fund to Fight AIDS, Tuberculosisa and Malaria reports:
|disbursed for TB through 2010||smear positive TB cases treated through 2011-06(?)||$/case|
|East Asia and Pacific||$513m||3.90m||$130|
|Eastern Africa and Indian Ocean||$182m||.68m||$270|
|Eastern Europe and Central Asia||$322m||.31m||$1000|
|Latin America and Caribbean||$162m||.15m||$1100|
|Middle East and North Africa||$166m||.24m||$690|
|South and West Asia||$285m||1.90m||$150|
|West and Central Africa||$190m||.35m||$540|
By way of comparison the US Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 promises to treat 4.5m DOTS cases and 90k MDR-TB cases for $4b in TB funding. Or $870/case. However we understand that the funding and treatment targets for this act were arrived at separately, and thus are not expected to be in sync. Thus we ignore the per case cost of this act.
How effective is the treatment of TB? The Disease Control Priorities Project (DCP2) pg. 294 reports 82% of cases treated are cured.
What is the mortality rate of untreated TB? In Natural history of tuberculosis: duration and fatality of untreated pulmonary tuberculosis in HIV negative patients: a systematic review it is reported: "Untreated smear-positive tuberculosis among HIV negative individuals has a 10-year case fatality variously reported between 53% and 86%, with a weighted mean of 70%."
How much of the burden of untreated TB is in the form of mortality? The DCP2 pg. 293 lists 86% of the DALY burden of TB being in the form of mortality.
|Project||Cost||Real world outcome||Outcome estimates||Economic value in Western terms||Leverage Factor|
|Cure Tuberculosis (Global Fund and DCP2)||$240||save 67% of a life||assume global program (could almost double effectiveness if focus on East Asia); assume data given above; 1 treatment results in 82% * 70% / 86% = 67% of a life saved||$1,300,000||6,000|
|Cure Tuberculosis (Solutions to the World's Biggest Problems, Bjorn Lomborg, 2007, pp. 325)||$1b/yr||30m DALYs/yr||-||$2.7t||2,700|
|Cure Tuberculosis (DCP2 / Priorities in Healthcare, The World Bank, 2006, pp. 71)||$5-50/DALY||1 DALY saved||excludes Europe and Central Asia||$90k||1,800 - 18,000|
Note that except for DCP2 / Priorities in Healthcare our estimated economic value does not include the reduced risk of infection to others as a result of the case being cured, and the DCP2 / Priorities in Healthcare case assumes a non-epidemic endemic scenario for retransmission.
Due to the large size of the Global Fund we consider the cost effectiveness of its work fairly definitive.