{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T01:20:58Z","timestamp":1777944058949,"version":"3.51.4"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Undernutrition is the leading cause of tuberculosis (TB) globally, but nutritional interventions are often considered cost-prohibitive. The RATIONS study demonstrated that nutritional supplementation to household contacts of persons with TB can reduce TB incidence, yet economic evaluations of such strategies remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a Markov model, we assessed the cost-effectiveness of a RATIONS-style intervention (monthly food basket providing 750 kcal, 23\u2005g of protein, and a multi-micronutrient tablet daily) for household contacts of persons with TB, as compared to no nutritional support. We calculated health outcomes (TB episodes, TB deaths, and disability-adjusted life years [DALYs]) over the lifetime of intervention recipients and assessed costs from healthcare and societal perspectives. We tested the robustness of results to parameter changes via deterministic and probabilistic sensitivity analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Over 2 years, household contacts receiving the RATIONS intervention experienced 38% (95% uncertainty interval [UI]: 23\u201352) fewer TB episodes and 58% (95% UI: 44\u201370) fewer TB deaths. Over the lifetime of a cohort of 100 000 household contacts, the intervention was projected to avert 11 524 DALYs (95% UI: 7446\u201317 393) and was cost-effective from both the healthcare (incremental cost-effectiveness ratio [ICER]: $289 per DALY averted [95% UI: 156\u2013537]) and societal perspectives ($229 per DALY averted [95% UI: 102\u2013468]). Cost-effectiveness was most sensitive to the cost of the nutritional supplement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Prompt nutritional support for household contacts of persons with TB disease would be cost-effective in reducing TB incidence and mortality in India.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciaf400","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T11:16:49Z","timestamp":1753096609000},"page":"1126-1134","source":"Crossref","is-referenced-by-count":1,"title":["In-kind Nutritional Supplementation for Persons With Drug-susceptible Tuberculosis and Their Household Contacts Would be Cost-effective for Reducing Tuberculosis Incidence and Mortality in Jharkhand, India: A Modeling Study"],"prefix":"10.1093","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4233-0871","authenticated-orcid":false,"given":"Pranay","family":"Sinha","sequence":"first","affiliation":[{"name":"Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine , Boston, Massachusetts ,","place":["USA"]},{"name":"Section of Infectious Disease, Boston Medical Center , Boston, Massachusetts ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madhavi","family":"Bhargava","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Yenepoya Medical College , Mangalore ,","place":["India"]},{"name":"Center for Nutrition Studies, Yenepoya (Deemed to be University) , Mangalore ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4319-9788","authenticated-orcid":false,"given":"Madolyn R","family":"Dauphinais","sequence":"additional","affiliation":[{"name":"Section of Infectious Disease, Boston Medical Center , Boston, Massachusetts ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6648-830X","authenticated-orcid":false,"given":"Madeline E","family":"Carwile","sequence":"additional","affiliation":[{"name":"Section of Infectious Disease, Boston Medical Center , Boston, Massachusetts ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr.","given":"C Robert","family":"Horsburgh","sequence":"additional","affiliation":[{"name":"Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine , Boston, Massachusetts ,","place":["USA"]},{"name":"Section of Infectious Disease, Boston Medical Center , Boston, Massachusetts ,","place":["USA"]},{"name":"Departments of Epidemiology, Global Health, and Biostatistics, Boston University School of Public Health , Boston, Massachusetts ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Urvashi B","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Microbiology, All India Institute of Medical Sciences , New Delhi ,","place":["India"]},{"name":"Central Tuberculosis Division, National Tuberculosis Elimination Programme , New Delhi ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonali","family":"Sarkar","sequence":"additional","affiliation":[{"name":"Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research , Puducherry ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anurag","family":"Bhargava","sequence":"additional","affiliation":[{"name":"Department of Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka ,","place":["India"]},{"name":"Department of Medicine, McGill University , Montreal, Quebec ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2571-016X","authenticated-orcid":false,"given":"Nicolas A","family":"Menzies","sequence":"additional","affiliation":[{"name":"Center for Health Decision Sciences, Harvard TH Chan School of Public Health , Boston, Massachusetts ,","place":["USA"]},{"name":"Department of Global Health and Population, Harvard TH Chan School of Public Health , Boston, Massachusetts ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,8,20]]},"reference":[{"key":"2026020907383678000_ciaf400-B1","volume-title":"Global tuberculosis report 2024","author":"World Health 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