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.

Abstract

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. Using a Markov model, we assessed the cost-effectiveness of a RATIONS-style intervention (monthly food basket providing 750 kcal, 23 g 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. Over 2 years, household contacts receiving the RATIONS intervention experienced 38% (95% uncertainty interval [UI]: 23-52) fewer TB episodes and 58% (95% UI: 44-70) 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: 7446-17 393) and was cost-effective from both the healthcare (incremental cost-effectiveness ratio [ICER]: $289 per DALY averted [95% UI: 156-537]) and societal perspectives ($229 per DALY averted [95% UI: 102-468]). Cost-effectiveness was most sensitive to the cost of the nutritional supplement. Prompt nutritional support for household contacts of persons with TB disease would be cost-effective in reducing TB incidence and mortality in India.