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.

Summary

This economic modelling study, informed by the RATIONS trial, assessed the cost-effectiveness of providing household contacts of tuberculosis patients with monthly food baskets (750 kcal, 23 g protein) and daily multi-micronutrient supplementation in Jharkhand, India. The intervention was projected to reduce TB episodes by 38% and TB deaths by 58% over 2 years, with an ICER of $289 per DALY averted from a healthcare perspective and $229 from a societal perspective, both well below typical cost-effectiveness thresholds for India. The findings suggest that prompt nutritional support for TB-exposed contacts would be economically justified as a public health intervention.

Regional applicability

This study was conducted in an Indian setting (Jharkhand) with economic parameters specific to India's healthcare system and TB burden. The findings are directly applicable to TB control policy and budgeting in India. Transferability to United Kingdom settings would be limited due differences in TB epidemiology, TB transmission patterns in household contacts, income levels, and healthcare costs, though the methodological approach may inform similar analyses in higher-incidence settings within or outside the UK.

Key measures

Incremental cost-effectiveness ratio (ICER) in dollars per DALY averted from healthcare and societal perspectives; percentage reduction in TB episodes and TB deaths; DALYs averted over lifetime

Outcomes reported

The study modelled the cost-effectiveness of nutritional supplementation (food basket plus micronutrient tablet) provided to household contacts of tuberculosis patients over 2 years and lifetime, measuring TB episodes prevented, TB deaths averted, and disability-adjusted life years gained.

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