McQuaid Christopher Finn, Clark Rebecca A, White Richard G, Bakker Roel, Alexander Peter, Henry Roslyn, Velayutham Banurekha, Muniyandi Malaisamy, Sinha Pranay, Bhargava Madhavi, Bhargava Anurag, Houben Rein M G J
TB Modelling Group, TB Centre, and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
TB Modelling Group, TB Centre, and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Lancet Glob Health. 2025 Mar;13(3):e488-e496. doi: 10.1016/S2214-109X(24)00505-9. Epub 2025 Jan 14.
Approximately 20% of global tuberculosis incidence is attributable to undernutrition, increasing to more than a third in India. Targeting nutritional interventions to tuberculosis-affected households is a policy priority, but understanding of epidemiological and economic impacts is limited. We aimed to estimate the population-level epidemiological and economic effect of such an intervention.
We used a previously published, age-stratified, compartmental transmission model of tuberculosis in India, and incorporated explicit BMI strata linked to disease progression and treatment outcomes. We used results from a recent trial of an intervention in which nutritional support in the form of food baskets was provided to people initiating tuberculosis treatment and to their household contacts (1200 kcal for patients and 750 kcal for contacts) to inform estimates of the impact and costs of nutritional support. We estimated the numbers of cases of tuberculosis disease and deaths due to tuberculosis disease that could be averted from 2023 to 2035 under the intervention scenario.
Compared with a baseline with no nutritional intervention, at 50% coverage of adults on tuberculosis treatment and their households (around 23% of households affected by incident tuberculosis in India), providing the nutritional support intervention could prevent 361 200 (95% uncertainty interval 318 000-437 700) tuberculosis deaths and 880 700 (802 700-974 900) disease episodes from 2023 to 2035. This would be equivalent to averting approximately 4·6% (4·2-5·5) tuberculosis deaths and 2·2% (2·1-2·4) tuberculosis episodes. The additional health system cost would be US$1349 million (1221-1492), with an incremental cost-effectiveness ratio of $167 (147-187) per disability-adjusted life-year averted. The median number of households needed to treat to prevent one tuberculosis death was 24·4 and to prevent one tuberculosis case was 10·0.
A nutritional intervention for tuberculosis-affected households could avert a substantial amount of tuberculosis disease and death in India, and would be highly likely to be cost-effective on the basis of the tuberculosis-specific benefits alone.
None.
For the Bangla and Hindi translations of the abstract see Supplementary Materials section.
全球约20%的结核病发病率可归因于营养不良，在印度这一比例增至三分之一以上。针对受结核病影响的家庭开展营养干预是一项政策重点，但对其流行病学和经济影响的了解有限。我们旨在评估这种干预措施在人群层面的流行病学和经济效果。
我们使用了之前发表的印度结核病年龄分层的 compartments 传播模型，并纳入了与疾病进展和治疗结果相关的明确体重指数分层。我们利用了最近一项干预试验的结果，该试验以食物篮的形式为开始结核病治疗的患者及其家庭接触者提供营养支持（患者1200千卡，接触者750千卡），以估算营养支持的影响和成本。我们估计了在干预情景下2023年至2035年可避免的结核病病例数和结核病死亡数。
与无营养干预的基线情况相比，在50%的接受结核病治疗的成年人及其家庭中（约占印度受新发结核病影响家庭的23%）提供营养支持干预，从2023年至2035年可预防361200例（95%不确定区间318000 - 437700）结核病死亡和880700例（802700 - 974900）发病。这相当于避免约4.6%（4.2 - 5.5）的结核病死亡和2.2%（2.1 - 2.4）的结核病发病。额外的卫生系统成本将为13.49亿美元（12.21 - 14.92），每避免一个伤残调整生命年的增量成本效益比为167美元（147 - 187）。预防一例结核病死亡所需治疗的家庭中位数为24.4个，预防一例结核病病例所需治疗的家庭中位数为10.0个。
对受结核病影响的家庭进行营养干预可在印度避免大量结核病发病和死亡，仅基于结核病特定益处来看极有可能具有成本效益。
无。
摘要的孟加拉语和印地语翻译见补充材料部分。
