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Fighting TB matters since one case treated saves many others

Poor compliance and use of inaccurate tests can delay diagnosis, meaning ongoing transmission

opinion Updated: Apr 04, 2018 15:10 IST
A patient suffering from Tuberculosis takes his medicines. (Kalpak Pathak/HT Photo)
A patient suffering from Tuberculosis takes his medicines. (Kalpak Pathak/HT Photo)(Kalpak Pathak/HT Photo)

Prime Minister Narendra Modi has set the impressive goal of eradicating tuberculosis (TB)  in India by 2025. TB claims the lives of more than four lakh Indians every year. The prime minister has made it clear that now is not the time for the status quo to prevail.
New economic evidence commissioned by IndiaConsensus, a collaboration between Tata Trusts and the Copenhagen Consensus, shows that Prime Minister Modi is entirely right to focus on tuberculosis. In Andhra Pradesh and Rajasthan, Tata Trusts and the Copenhagen Consensus have worked with hundreds of stakeholders to identify the best policies in more than 40 areas. Top economists are generating tailor-made data on costs, benefits and impacts.

Nimalan Arinaminpathy from Imperial College, London, has analysed TB in Andhra Pradesh and Rajasthan. TB management is especially important because each case treated saves others. Managing this killer disease means more money to tackle other priorities. This analysis indicates that increasing the quality of TB care in the private sector would increase the number of TB patients in Rajasthan receiving high-quality treatment by more than one lakh over three decades, saving 3,300 lives every year on an average, or more than 11% of deaths.

Initiatives in Mumbai, Patna and elsewhere have shown it possible to engage the private sector, supported by public funds and overseen by the national TB programme. As the National Surveillance Programme 2017-25 outlines, well over half of TB cases first go to private clinics. Poor compliance and use of inaccurate tests can delay diagnosis, meaning ongoing transmission, while a general lack of treatment support means many private patients do not complete the standard TB regimen.

Using pilot study costs, and with the conservative estimate that while the intervention will pay for all private providers, only half will succeed. The average public cost for Rajasthan would be about Rs 15.2 crore per year between now and 2050. According to India Priorities research papers, this study uses cost-benefit analysis. Every rupee borne by Rajasthan and its population will generate Rs 179 of benefits, representing saved lives, fewer people being disabled, and quicker treatment initiation. (Calculations differ for Andhra Pradesh, but the analysis still shows a spectacular return).

At present, TB services largely wait for symptomatic patients to show up at a clinic. Going into a vulnerable community can diagnose patients earlier and shorten the period over which they are infectious. The NSP 2017-25 indicates urban slums as a priority. If Andhra Pradesh can save about 2,000 lives each year with private sector engagement, the analysis shows that adding active case finding will save almost twice as many.

The costs for Andhra Pradesh will run to Rs 43 crore on average per year, but cut multi-drug resistant cases by up to 80%. This means much lower costs in later years, allowing more spending on other healthcare challenges. This equals a return of more than Rs 100 for every rupee invested.

While the evidence only shows the remarkable returns for Rajasthan and Andhra Pradesh, it points the way for strong and smart action against TB across India.

Bjorn Lomborg is president, Copenhagen Consensus Centre Manorama Bakshi is senior advisor to the India Consensus projectThe views expressed are personal