Pranay Sinha1, Subitha L Lakshminarayanan2, Chelsie Cintron1, Prakash Babu Narasimhan2, Lindsey M Locks3,4, Nalin Kulatilaka5, Kimberly Maloomian6,7, Senbagavalli Prakash Babu2, Madeline E Carwile1, Anne F Liu8, C Robert Horsburgh1,4,9, Carlos Acuna-Villaorduna1, Benjamin P Linas1, Natasha S Hochberg1,9. 1. Section of Infectious Diseases, Department of Internal Medicine, School of Medicine, Boston University, Boston, Massachusetts, USA. 2. Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India. 3. Department of Health Sciences, Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, Massachusetts, USA. 4. Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA. 5. Susilo Institute for Ethics in a Global Economy, Boston University Questrom School of Business, Boston, Massachusetts, USA. 6. Center for Bariatric Surgery, Miriam Hospital, Providence, Rhode Island, USA. 7. Kimba's Kitchen, LLC, West Palm Beach, Florida, USA. 8. Brigham and Women's Hospital, Boston, Massachusetts, USA. 9. Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.
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. 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 3 groups: general population, household contacts (HHCs) of people living with TB, and persons living with human immunodeficiency virus (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/m2 until they attain a BMI of 20 kg/m2 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 persons with HIV, respectively. Augmented rations resulted in 10-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.
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. 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 3 groups: general population, household contacts (HHCs) of people living with TB, and persons living with human immunodeficiency virus (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/m2 until they attain a BMI of 20 kg/m2 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 persons with HIV, respectively. Augmented rations resulted in 10-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.
Authors: Masja Straetemans; Philippe Glaziou; Ana L Bierrenbach; Charalambos Sismanidis; Marieke J van der Werf Journal: PLoS One Date: 2011-06-27 Impact factor: 3.240
Authors: Cesar G Victora; Linda Adair; Caroline Fall; Pedro C Hallal; Reynaldo Martorell; Linda Richter; Harshpal Singh Sachdev Journal: Lancet Date: 2008-01-26 Impact factor: 79.321