{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T00:12:32Z","timestamp":1793232752827,"version":"4.5.0"},"reference-count":32,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T00:00:00Z","timestamp":1703030400000},"content-version":"unspecified","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Advance Access & Delivery","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"DOI":"10.13039\/100011886","name":"Dubai Harvard Foundation for Medical Research","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100011886","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006691","name":"Harvard Medical School","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100006691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To estimate the economic impact of failure to find and treat tuberculosis disease and prevent tuberculosis infection from progressing to active disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Estimating the economic cost of not finding and treating a patient suffering from tuberculosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Estimation methodology is developed in the Indian context, as informed by local costs and reported tuberculosis epidemiology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>No individual participants were included.<\/jats:p><\/jats:sec><jats:sec><jats:title>Primary and secondary outcome measures<\/jats:title><jats:p>The primary outcome measure is the total cost of patients with drug-susceptible and drug-resistant tuberculosis who are and are not found and treated by tuberculosis programmes, including costs for medications, lost productivity, healthcare services and furthered transmission. We calculate the economic burdens by varying the number of individuals a person sick with tuberculosis infects (10 or 15 people) and the risk of progression to tuberculosis disease if infected (5 or 8%). The secondary outcome measure is the amount saved by finding a patient early or who would not have otherwise been found. All costs are presented in US dollars (exchange rate: 72 Indian rupees\/1 US$).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>By finding and treating a patient early before furthered transmission occurs\u2014or stopping progression of tuberculosis infection to tuberculosis disease with preventive therapy\u2014the Indian health system can save US$5502 to US$15\u2009825 and US$5846 to US$25 575, for<jats:italic>each<\/jats:italic>individual with drug-susceptible and drug-resistant tuberculosis, respectively, across scenarios.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These estimates provide crude, lower bounds for the potential costs of not appropriately diagnosing and treating a single patient with active tuberculosis in a timely manner, or preventing a patient with tuberculosis infection from progressing to active disease. The actual financial burden on society is far higher than estimated using this simple, short-term cost-effective analyses. Our results highlight the limitations of tuberculosis costing models to date, and demonstrate the importance of accounting for airborne transmission of tuberculosis.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2022-070717","type":"journal-article","created":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T06:45:34Z","timestamp":1703141134000},"page":"e070717","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Cost of inaction: a framework to estimate the economic cost of missing a patient with tuberculosis in the Indian context"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1022-2515","authenticated-orcid":false,"given":"Meredith B","family":"Brooks","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viswanath","family":"Pingali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Nicholson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salmaan","family":"Keshavjee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,12,20]]},"reference":[{"key":"2023122022450842000_13.12.e070717.1","unstructured":"WHO . Global tuberculosis report 2017. Geneva: World Health Organization, 2017: 249."},{"key":"2023122022450842000_13.12.e070717.2","unstructured":"WHO . Global tuberculosis report 2021. Geneva: World Health Organization, 2021: 25."},{"key":"2023122022450842000_13.12.e070717.3","unstructured":"Global TB . The Price of a Pandemic. London: Global TB Caucus, 2017. Available: https:\/\/www.globaltbcaucus.org\/en-research"},{"key":"2023122022450842000_13.12.e070717.4","doi-asserted-by":"crossref","unstructured":"Maher D . Tuberculosis: A Comprehensive Clinical Reference. Elsevier Health Sciences, 2009: 129\u201332.","DOI":"10.1016\/B978-1-4160-3988-4.00013-5"},{"key":"2023122022450842000_13.12.e070717.5","first-page":"1183","article-title":"Active case finding of tuberculosis: historical perspective and future prospects","volume":"9","author":"Golub","year":"2005","journal-title":"Int J Tuberc Lung Dis"},{"key":"2023122022450842000_13.12.e070717.6","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.13.0834"},{"key":"2023122022450842000_13.12.e070717.7","doi-asserted-by":"crossref","unstructured":"Escombe AR , Moore DAJ , Gilman RH , et al . The Infectiousness of tuberculosis patients Coinfected with HIV. PLoS Med 2008;5:e188. doi:10.1371\/journal.pmed.0050188","DOI":"10.1371\/journal.pmed.0050188"},{"key":"2023122022450842000_13.12.e070717.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.trstmh.2008.04.027"},{"key":"2023122022450842000_13.12.e070717.9","doi-asserted-by":"crossref","first-page":"e46","DOI":"10.1016\/S0140-6736(15)00320-7","article-title":"Stopping the body count: a comprehensive approach to move towards zero tuberculosis deaths","volume":"386","author":"Keshavjee","year":"2015","journal-title":"Lancet"},{"key":"2023122022450842000_13.12.e070717.10","doi-asserted-by":"crossref","unstructured":"Akolo C , Adetifa I , Shepperd S , et al . Treatment of latent tuberculosis infection in HIV infected persons. Cochrane Database of Syst Rev 2010:CD000171. doi:10.1002\/14651858.CD000171.pub3","DOI":"10.1002\/14651858.CD000171.pub3"},{"key":"2023122022450842000_13.12.e070717.11","doi-asserted-by":"crossref","unstructured":"Smieja M , Marchetti C , Cook D , et al . Isoniazid for preventing tuberculosis in non-HIV infected persons. Cochrane Database of Systematic Reviews 2000:CD001363. doi:10.1002\/14651858.CD001363","DOI":"10.1002\/14651858.CD001363"},{"key":"2023122022450842000_13.12.e070717.12","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit643"},{"key":"2023122022450842000_13.12.e070717.13","first-page":"920","article-title":"The continued decline of the tuberculosis epidemic","volume":"105","author":"Kaplan","year":"1970","journal-title":"Am Rev Respir Dis"},{"key":"2023122022450842000_13.12.e070717.14","first-page":"329","article-title":"Global, regional, and national burden of tuberculosis, 1990-2016: results from the global burden of diseases, injuries, and risk factors 2016 study","volume":"18","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"2023122022450842000_13.12.e070717.15","unstructured":"The Stop TB . Geneva: United Nations Office for Project Services; UN high-level meeting on TB: key targets & commitments for 2022, . 2018 Available: https:\/\/www.stoptb.org\/advocacy-and-communications\/unhlm-tb-key-targets-and-commitments"},{"key":"2023122022450842000_13.12.e070717.16","doi-asserted-by":"crossref","unstructured":"Dodd PJ , White RG , Corbett EL . Periodic active case finding for TB: when to look PLoS One 2011;6:e29130. doi:10.1371\/journal.pone.0029130","DOI":"10.1371\/journal.pone.0029130"},{"key":"2023122022450842000_13.12.e070717.17","doi-asserted-by":"crossref","first-page":"926","DOI":"10.5588\/ijtld.15.1001","article-title":"Estimating tuberculosis cases and their economic costs averted in the United States over the past two decades","volume":"20","author":"Castro","year":"2016","journal-title":"Int J Tuberc Lung Dis"},{"key":"2023122022450842000_13.12.e070717.18","unstructured":"WHO . Who global tuberculosis report 2020 country profile. Geneva: World Health Organization, 2020. Available: https:\/\/www.who.int\/docs\/default-source\/hq-tuberculosis\/global-tuberculosis-report-2020\/country-profile-2020-final-web-min.pdf?sfvrsn=b4137a1c_0"},{"key":"2023122022450842000_13.12.e070717.19","unstructured":"WHO . Guidelines for treatment of drug-susceptible tuberculosis and patient care, 2017 update. Geneva: World Health Organization, 2017: 80. Available: http:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/255052\/9789241550000-eng.pdf"},{"key":"2023122022450842000_13.12.e070717.20","doi-asserted-by":"crossref","first-page":"110","DOI":"10.5588\/pha.20.0017","article-title":"How much do Indians pay for tuberculosis treatment? A cost analysis","volume":"10","author":"Sinha","year":"2020","journal-title":"Public Health Action"},{"key":"2023122022450842000_13.12.e070717.21","unstructured":"NIH . Washington, DC: Department of Health and Human Services; Panel on Opportunistic Infections in Adults and Adolescents with HIV: Guidelines for the Prevention and treatment of opportunistic infections in adults and adolescents with HIV, . 2021 Available: https:\/\/aidsinfo.nih.gov\/guidelines\/html\/4\/adult-and-adolescent-opportunistic-infection\/356\/tb-drug-dosing"},{"key":"2023122022450842000_13.12.e070717.22","unstructured":"The Gazette of India . State-wise wage rate for unskilled manual workers (rupees per day). New Delhi: Government of India Press; 2020. Available: https:\/\/nrega.nic.in\/netnrega\/writereaddata\/Circulars\/2410Wage_rate_notification_for_FY2020-21.pdf"},{"key":"2023122022450842000_13.12.e070717.23","unstructured":"LiveChennai.com . Chennai, India: LiveChennai.com. Construction workers daily pay list in Chennai, Available: https:\/\/www.livechennai.com\/construction_workers_daily_pay_List_Chennai.asp"},{"key":"2023122022450842000_13.12.e070717.24","doi-asserted-by":"crossref","unstructured":"Kapoor SK , Raman AV , Sachdeva KS , et al . How did TB patients reach DOTS services in Delhi? a study of patient treatment behavior. PLoS ONE 2012;7:e42458. doi:10.1371\/journal.pone.0042458","DOI":"10.1371\/journal.pone.0042458"},{"key":"2023122022450842000_13.12.e070717.25","unstructured":"MediFee . Pune, India: MediFee. Sputum routine test cost, Available: https:\/\/www.medifee.com\/tests\/sputum-routine-test-cost\/"},{"key":"2023122022450842000_13.12.e070717.26","unstructured":"Iyer M . MDR-TB treatment could cost up to 25L in Mumbai, says study. In: The Economic Times of India [Internet]. 2016. Available: https:\/\/health.economictimes.indiatimes.com\/news\/diagnostics\/mdr-tb-treatment-could-cost-up-to-25l-in-mumbai-says-study\/54647853"},{"key":"2023122022450842000_13.12.e070717.27","unstructured":"WHO . Geneva: World Health Organization. The shorter MDR-TB regimen, Available: https:\/\/www.tbonline.info\/media\/uploads\/documents\/short_mdr_regimen_factsheet.pdf"},{"key":"2023122022450842000_13.12.e070717.28","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.jhealeco.2015.09.001","article-title":"The consumer welfare implications of governmental policies and firm strategy in markets for medicines","volume":"44","author":"Chatterjee","year":"2015","journal-title":"J Health Econ"},{"key":"2023122022450842000_13.12.e070717.29","first-page":"1112","article-title":"Risk factors for developing tuberculosis: a 12-year follow up of contacts of tuberculosis cases","volume":"14","author":"Mor\u00e1n-Mendoza","year":"2010","journal-title":"Int J Tuberc Lung Dis"},{"key":"2023122022450842000_13.12.e070717.30","doi-asserted-by":"crossref","unstructured":"Shewade HD , Gupta V , Satyanarayana S , et al . Patient characteristics, health seeking and delays among new Sputum smear positive TB patients identified through active case finding when compared to passive case finding in India. PLoS One 2019;14:e0213345. doi:10.1371\/journal.pone.0213345","DOI":"10.1371\/journal.pone.0213345"},{"key":"2023122022450842000_13.12.e070717.31","first-page":"1","article-title":"Targeted Tuberculin testing and treatment of latent tuberculosis infection","volume":"49","year":"2000","journal-title":"MMWR"},{"key":"2023122022450842000_13.12.e070717.32","doi-asserted-by":"publisher","DOI":"10.9745\/GHSP-D-18-00318"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2022-070717","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T06:45:46Z","timestamp":1703141146000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2022-070717"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12]]},"references-count":32,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12,20]]},"published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1136\/bmjopen-2022-070717"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2022-070717","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12]]}}}