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Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa: a combined analysis of nine models Prof Nicolas A Menzies, PhD, Gabriela B Gomez, PhD, Fiammetta Bozzani, MSc, Susmita Chatterjee, PhD, Nicola Foster, MPH, Ines Garcia Baena, MSc, Yoko V Laurence, MSc, Prof Sun Qiang, PhD, Andrew Siroka, PhD, Sedona Sweeney, MSc, Stéphane Verguet, PhD, Nimalan Arinaminpathy, DPhil, Andrew S Azman, PhD, Eran Bendavid, MD, Stewart T Chang, PhD, Prof Ted Cohen, DPH, Justin T Denholm, PhD, David W Dowdy, MD, Philip A Eckhoff, PhD, Jeremy D Goldhaber-Fiebert, PhD, Andreas Handel, PhD, Grace H Huynh, PhD, Marek Lalli, MSc, Hsien-Ho Lin, ScD, Sandip Mandal, PhD, Emma S McBryde, PhD, Surabhi Pandey, PhD, Prof Joshua A Salomon, PhD, Sze-chuan Suen, MS, Tom Sumner, PhD, James M Trauer, MBBS, Bradley G Wagner, PhD, Prof Christopher C Whalen, MD, Chieh-Yin Wu, MS, Delia Boccia, PhD, Vineet K Chadha, MD, Salome Charalambous, PhD, Daniel P Chin, MD, Prof Gavin Churchyard, PhD, Colleen Daniels, MA, Puneet Dewan, MD, Lucica Ditiu, MD, Jeffrey W Eaton, PhD, Prof Alison D Grant, PhD, Piotr Hippner, MSc, Mehran Hosseini, MD, David Mametja, MPH, Carel Pretorius, PhD, Yogan Pillay, PhD, Kiran Rade, MD, Suvanand Sahu, MD, Lixia Wang, MS, Rein M G J Houben, PhD, Michael E Kimerling, MD, Richard G White, PhD, Anna Vassall, PhD The Lancet Global Health Volume 4, Issue 11, Pages e816-e826 (November 2016) DOI: /S X(16) Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license Terms and Conditions
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Figure 1 Incremental tuberculosis service costs for 2016–35 for each intervention scenario, compared with the base case, by country and model Costs below $0 represent cost savings compared with the base case. Intervention scenarios for each country are described in table 1, and details of each model are provided in table 2 and by Houben and colleagues.2 IPT=isoniazid preventive therapy. MDR=multidrug-resistant. *Sum of all cost categories. The Lancet Global Health 2016 4, e816-e826DOI: ( /S X(16) ) Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license Terms and Conditions
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Figure 2 Incremental patient-incurred costs for 2016–35, for each intervention scenario, compared with the base case, by country and model Costs below $0 represent cost savings compared with the base case. Intervention scenarios for each country are described in table 1, and details of each model are provided in table 2 and by Houben and colleagues.2 IPT=isoniazid preventive therapy. The Lancet Global Health 2016 4, e816-e826DOI: ( /S X(16) ) Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license Terms and Conditions
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Figure 3 Cost-effectiveness ratios of intervention scenarios compared with base case Costs and DALYs were summed over the period 2016–35, discounted at 3% per year. Values and bold lines connected to the origin represent cost-effectiveness ratios calculated from costs and health benefits averaged across models. Dominant scenarios represent improved health and reduced costs compared with the base case. Dashed lines connect individual model results to the overall average. Shaded areas represent the region spanned by the set of model results for each intervention scenario, and reflect the relative heterogeneity of findings for a particular scenario. Intervention scenarios for each country are described in table 1. DALYs=disability-adjusted life-years. IPT=isoniazid preventive therapy. The Lancet Global Health 2016 4, e816-e826DOI: ( /S X(16) ) Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license Terms and Conditions
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Figure 4 Time trends in annual tuberculosis service costs estimated for each scenario, 2016–35 Shaded regions represent annual cost of each cost component averaged across models. Costs were estimated at 2014 price levels and not discounted. Intervention scenarios for each country are described in table 1. IPT=isoniazid preventive therapy. MDR=multidrug-resistant. The Lancet Global Health 2016 4, e816-e826DOI: ( /S X(16) ) Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license Terms and Conditions
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