Nutritional Supplementation Would Be Cost-Effective for Reducing Tuberculosis Incidence and Mortality in India: The Ration Optimization to Impede Tuberculosis (ROTI-TB) Model

Abstract

Background Undernutrition is the leading cause of tuberculosis (TB) in India and is associated with increased TB mortality. Undernutrition also decreases quality of life and economic productivity. Material and Methods We assessed the cost-effectiveness of providing augmented rations to undernourished Indians through the government’s Targeted Public Distribution System (TPDS). We used Markov state transition models to simulate disease progression and mortality among undernourished individuals in three groups: general population, household contacts (HHCs) of people living with TB, and persons with HIV. The models calculate costs and outcomes (TB cases, TB deaths, and disability-adjusted life years, DALYs) associated with a 2600 KCal/day diet for adults with body mass index [BMI] of 16-18.4 kg/m 2 until they attain a BMI of 20kg/m 2 compared to a status quo scenario wherein TPDS rations are unchanged. We employed deterministic and probabilistic sensitivity analyses to test result robustness. Results Over 5 years, augmented rations could avert 81% of TB cases and 88% of TB deaths among currently undernourished Indians. Correspondingly, this intervention could forestall 78% and 48% of TB cases and prevent 88% and 70% of deaths among undernourished HHCs and HIV-infected persons, respectively. Augmented rations resulted in ten-fold higher resolution of undernutrition and were highly cost-effective with (incremental cost effectiveness ratio (ICER) of $470/DALY averted). ICER was lower for HHCs ($360/DALY averted) and the HIV population ($250/DALY averted). Conclusions A robust nutritional intervention would be highly cost-effective in reducing TB incidence and mortality while reducing chronic undernutrition in India.

In-kind nutritional supplementation for household contacts of persons with tuberculosis would be cost-effective for reducing tuberculosis incidence and mortality in India: a modeling study

“…(13) Forth, the model did not capture the positive externalities of nutritional support, including improvements in nutritional status and functional recovery and improved economic productivity among TB survivors, which have been explored in a previous analysis. (26) Taken together, these limitations suggest that our ICER estimates will be conservative, and that nutritional support could be even more cost-effective than we project.…”

A nomogram for predicting mortality of patients initially diagnosed with primary pulmonary tuberculosis in Hunan province, China: a retrospective study.

“…A survival analysis of TB deaths from the Tuberculosis Disease and Mortality Surveillance Information System in Zhejiang province, China, concluded that 71.1% of 283 deaths caused by TB occurred within three years of diagnosis and treatment (33). The main reason for this difference is that TB is closely related to body nutrition as a type of immune disease, and individual nutritional status is closely related to individual economic and socioeconomic status (34)(35)(36). Therefore, we discovered that the results of a prognostic model are different for TB patients in different regions.…”

Nutritional status in patients with active pulmonary tuberculosis and new nutritional risk screening model for active tuberculosis: a national, multicenter, cross-sectional study in China

“…Clinicians have observed that many patients had malnutrition which might impact the treatment outcome. Nutritional supplementation can contribute to controlling TB and reducing mortality, as reported in India ( 8 ). Study has indicated that interventions with high-energy supplements such as a high-cholesterol diet, vitamins A and D, and multiple micronutrient supplements can help patients with active TB gain weight ( 9 ).…”

“…To our knowledge, few studies have evaluated and compared the utility of the NRS 2002 and GLIM for nutritional diagnosis of active PTB. Therefore, the present study aimed to provide the first evidence for malnutrition and further help to improve the outcome of patients with active PTB ( 8 ), especially for multidrug-resistant TB, which has represented the main challenge for TB control. We present this article in accordance with the TRIPOD reporting checklist (available at https://jtd.amegroups.com/article/view/10.21037/jtd-23-623/rc ).…”