Economic impact of tuberculosis mortality in 120 countries and the cost of not achieving the Sustainable Development Goals tuberculosis targets: a full-income analysis

Abstract

Background The tuberculosis targets for the UN Sustainable Development Goals (SDGs) call for a 90% reduction in tuberculosis deaths by 2030, compared with 2015, but meeting this target now seems highly improbable. To assess the economic impact of not meeting the target until 2045, we estimated full-income losses in 120 countries, including those due to excess deaths resulting from COVID-19-related disruptions to tuberculosis services, for the period 2020–50. Methods Annual mortality risk changes at each age in each year from 2020 to 2050 were estimated for 120 countries. This risk change was then converted to full-income risk by calculating a population-level mortality risk change and multiplying it by the value of a statistical life-year in each country and year. As a comparator, we assumed that current rates of tuberculosis continue to decline through the period of analysis. We calculated the full-income losses, and mean life expectancy losses per person, at birth and at age 35 years, under scenarios in which the SDG targets are met in 2030 and in 2045. We defined the cost of inaction as the difference in full-income losses and tuberculosis mortality between these two scenarios. Findings From 2020 to 2050, based on the current annual decrease in tuberculosis deaths of 2%, 31·8 million tuberculosis deaths (95% uncertainty interval 25·2 million–39·5 million) are estimated to occur, corresponding to an economic loss of US$17·5 trillion (14·9 trillion–20·4 trillion). If the SDG tuberculosis mortality target is met in 2030, 23·8 million tuberculosis deaths (18·9 million–29·5 million) and $13·1 trillion (11·2 trillion–15·3 trillion) in economic losses can be avoided. If the target is met in 2045, 18·1 million tuberculosis deaths (14·3 million–22·4 million) and $10·2 trillion (8·7 trillion–11·8 trillion) can be avoided. The cost of inaction of not meeting the SDG tuberculosis mortality target until 2045 ( vs 2030) is, therefore, 5·7 million tuberculosis deaths (5·1 million–8·1 million) and $3·0 trillion (2·5 trillion–3·5 trillion) in economic losses. COVID-19-related disruptions add $290·3 billion (260·2 billion–570·1 billion) to this cost. Interpretation Failure to achieve the SDG tuberculosis mortality target by 2030 will lead to profound economic and health losses. The effects of delay will be greatest in sub-Saharan Africa. Affected countries, donor nations, and the private sector should redouble efforts to finance tuberculosis programmes and research because the economic dividend of such strategies is likely to be substantial. Funding None.

Perspectives d’élimination de la tuberculose : la stratégie OMS à l’épreuve de la pandémie de COVID-19

“…À l'exception de l'infection par le VIH, ces facteurs ne sont pas encore pris en compte de manière exhaustive par les programmes de santé publique dans les pays à ressources limitées [27] . Enfin, les aspects socio-économiques restent primordiaux [28] : maladie de la pauvreté par essence, la tuberculose peut aussi générer de la pauvreté en raison de la perte de revenus, ou du fait de coûts catastrophiques pour la famille, donnant lieu à un cercle vicieux « tuberculose-pauvreté » que les stratégies biomédicales ne peuvent à elles seules briser [26] .…”

Estimating the contribution of subclinical tuberculosis disease to transmission – an individual patient data analysis from prevalence surveys

“…An estimated 1.5-million people died from tuberculosis (TB) disease in 2020, and TB is on course to retake its position as the largest cause of death by a single infectious agent [1]. Fuelled by ongoing transmission through exhaled or expectorated Mycobacterium tuberculosis ( Mtb ) bacteria, TB incidence is declining at a rate of 1-2% per annum, which is too slow given the risk and scale of mortality [1,2], lifelong impairment [3,4], poverty [5] and macro-economic consequences [6]. Problematically, most Mtb transmission in high incidence settings remains unaccounted for [3], with less than one-in-ten occurrences of TB explained by transmission from a known contact [7].…”

The cost and cost-effectiveness of novel tuberculosis vaccines in low- and middle-income countries: a modelling study

“…The cost of not meeting the End TB Targets by 2030 and facing the excess deaths resulting from COVID-19-related disruptions to TB services may translate into 31•8 million TB deaths globally corresponding to an economic loss of $17•5 trillion between 2020 and 2050. 3 Developing new safe, affordable, and effective TB vaccines is critical for achieving these targets. While promising candidates exist (for example, the M72/AS01E candidate vaccine 4 ), limited market incentives to invest in TB prevention has delayed the development of novel TB vaccines.…”