{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T08:08:20Z","timestamp":1771920500125,"version":"3.50.1"},"posted":{"date-parts":[[2025,9,4]]},"group-title":"Public and Global Health","reference-count":65,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T00:00:00Z","timestamp":1756944000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,1,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>While a range of interventions exist for tuberculosis prevention, screening, diagnosis, and treatment, their potential population impact and cost-effectiveness are seldom directly compared, or evaluated between settings with different background TB epidemiology and structural drivers.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We calibrated a deterministic TB model to epidemiological indicators in Brazil, India, and South Africa. We implemented seven interventions across countries focusing on prevention, screening and diagnosis, and treatment of TB, as well as TB screening in prisons in Brazil and nutritional supplementation in India. We standardised scale-up (2025-2030), coverage (80% of target population), and strength of evidence for epidemiological impact using published efficacy data. We estimated epidemiological impact and incremental cost-effectiveness ratios (ICERs), expressed as costs per disability-adjusted life year (DALY) averted by 2050.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Only three interventions prevented &gt;10% of incident TB episodes by 2050: vaccination (median 15-28% across countries), symptom-agnostic community-wide screening (32-38%) and screening in prisons (23%). The impact of other interventions was more limited, ranging from 0% (shortened drug-susceptible treatment) to 5% (nutritional supplementation). ICERs varied widely by intervention and setting. Shortened drug-resistant treatment was cost-saving across settings, with the next lowest ICERs for prison screening in Brazil (72 USD\/DALY) and nutritional supplementation in India (167 USD\/DALY). Within each country, both low-cost community-wide screening and TB vaccine campaigns had lower USD\/DALY than TB preventive treatment.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Interventions with meaningful epidemiological impact can also be cost-effective, but need to target populations beyond clinic-diagnosed individuals or their households. Achieving such potential requires a priority shift in funding, policy and product development.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2025.09.02.25334943","type":"posted-content","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T20:25:16Z","timestamp":1757017516000},"source":"Crossref","is-referenced-by-count":0,"title":["The potential impact, cost and cost-effectiveness of tuberculosis interventions - a modelling exercise"],"prefix":"10.64898","author":[{"given":"Katherine C.","family":"Horton","sequence":"first","affiliation":[{"name":"TB Modelling Group, TB Centre, LSHTM, London, UK"},{"name":"Department of Infectious Disease Epidemiology, LSHTM, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alvaro","family":"Schwalb","sequence":"additional","affiliation":[{"name":"TB Modelling Group, TB Centre, LSHTM, London, UK"},{"name":"Department of Infectious Disease Epidemiology, LSHTM, London, UK"},{"name":"Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin J.","family":"Harker","sequence":"additional","affiliation":[{"name":"TB Modelling Group, TB Centre, LSHTM, London, UK"},{"name":"Department of Infectious Disease Epidemiology, LSHTM, London, UK"},{"name":"Global Health Economics Centre, LSHTM, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lara","family":"Gosc\u00e9","sequence":"additional","affiliation":[{"name":"TB Modelling Group, TB Centre, LSHTM, London, UK"},{"name":"Department of Infectious Disease Epidemiology, LSHTM, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Venero-Garcia","sequence":"additional","affiliation":[{"name":"TB Modelling Group, TB Centre, LSHTM, London, UK"},{"name":"Department of Infectious Disease Epidemiology, LSHTM, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lily","family":"O\u2019Brien","sequence":"additional","affiliation":[{"name":"TB Modelling Group, TB Centre, LSHTM, London, UK"},{"name":"Department of Infectious Disease Epidemiology, LSHTM, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arkaprabha","family":"Gun","sequence":"additional","affiliation":[{"name":"TB Modelling Group, TB Centre, LSHTM, London, UK"},{"name":"Department of Infectious Disease Epidemiology, LSHTM, London, UK"},{"name":"Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Sumner","sequence":"additional","affiliation":[{"name":"TB Modelling Group, TB Centre, LSHTM, London, UK"},{"name":"Department of Infectious Disease Epidemiology, LSHTM, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. Finn","family":"McQuaid","sequence":"additional","affiliation":[{"name":"TB Modelling Group, TB Centre, LSHTM, London, UK"},{"name":"Department of Infectious Disease Epidemiology, LSHTM, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca A.","family":"Clark","sequence":"additional","affiliation":[{"name":"TB Modelling Group, TB Centre, LSHTM, London, UK"},{"name":"Department of Infectious Disease Epidemiology, LSHTM, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomos O.","family":"Prys-Jones","sequence":"additional","affiliation":[{"name":"TB Modelling Group, TB Centre, LSHTM, London, UK"},{"name":"Department of Infectious Disease Epidemiology, LSHTM, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roel","family":"Bakker","sequence":"additional","affiliation":[{"name":"TB Modelling Group, TB Centre, LSHTM, London, UK"},{"name":"Department of Infectious Disease Epidemiology, LSHTM, London, UK"},{"name":"KNCV Tuberculosis Foundation, The Hague, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yiran E","family":"Liu","sequence":"additional","affiliation":[{"name":"YEL \u2013 SEICHE Center for Health and Justice, Yale University School of Medicine, New Haven, CT, USA"},{"name":"YEL \u2013 Justice Collaboratory, Yale Law School, New Haven, CT, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mmamapudi","family":"Kubjane","sequence":"additional","affiliation":[{"name":"MK - Health Economics and Epidemiology Research Office, Wits Health Consortium, Johannesburg, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Lienhardt","sequence":"additional","affiliation":[{"name":"French Institute for Research in Sustainable Development (IRD), Montpellier, France"},{"name":"CRDF Global, Arlington, VA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard G.","family":"White","sequence":"additional","affiliation":[{"name":"TB Modelling Group, TB Centre, LSHTM, London, UK"},{"name":"Department of Infectious Disease Epidemiology, LSHTM, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4132-7467","authenticated-orcid":false,"given":"Rein M.G.J.","family":"Houben","sequence":"additional","affiliation":[{"name":"TB Modelling Group, TB Centre, LSHTM, London, UK"},{"name":"Department of Infectious Disease Epidemiology, LSHTM, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2026020310465117000_2025.09.02.25334943v2.1","unstructured":"World Health Organisation. 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