Abstract

Objectives

Tuberculosis (TB) disproportionately affects low-income populations because of socioeconomic barriers. Conditional cash transfers (CCTs) are promising strategies to improve treatment adherence, reduce economic hardship, and enhance health outcomes. However, few studies have examined their cost-effectiveness, especially when combined with TB counseling. The objective of this study is to estimate the long-term epidemiological impact and cost-effectiveness of CCT with pre- and posttest TB counseling in South Africa.

Methods

This analysis used results from a trial conducted in South Africa. Trial results on treatment initiation, treatment completion, and on-treatment mortality informed a transmission model of TB, in which a CCT intervention with pre- and posttest TB counseling was offered to all adults diagnosed with drug-susceptible TB between 2025 and 2050. Epidemiological modeling results were combined with cost data to determine the cost-effectiveness of the intervention compared with business as usual from the provider’s perspective.

Results

Universally applying the CCT intervention between 2025 and 2050 in South Africa would lead to a cumulative reduction of 5.1% (uncertainty interval [UI]: 4.6%-5.6%) incident cases and 9.5% (UI: 9.1%-10.2%) deaths, compared with business as usual. The incremental cost of the intervention was estimated at $80.4 USD per patient, leading to a total increase of 7.1% (UI:6.8-7.6%) in the TB budget and an incremental cost-effectiveness ratio of $144.45 per disability-adjusted life-years averted, making it cost-effective in South Africa, at a threshold of $3314 USD.

Conclusions

CCT interventions with pre- and posttest counseling would be cost-effective in South Africa, leading to a long-term reduction in TB incidence and mortality.