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Open Access 01-12-2017 | Research article

Counting the lives saved by DOTS in India: a model-based approach

Authors: Sandip Mandal, Vineet K. Chadha, Ramanan Laxminarayan, Nimalan Arinaminpathy

Published in: BMC Medicine | Issue 1/2017

Abstract

Background

Against the backdrop of renewed efforts to control tuberculosis (TB) worldwide, there is a need for improved methods to estimate the public health impact of TB programmes. Such methods should not only address the improved outcomes amongst those receiving care but should also account for the impact of TB services on reducing transmission.

Methods

Vital registration data in India are not sufficiently reliable for estimates of TB mortality. As an alternative approach, we developed a mathematical model of TB transmission dynamics and mortality, capturing the scale-up of DOTS in India, through the rollout of the Revised National TB Control Programme (RNTCP). We used available data from the literature to calculate TB mortality hazards amongst untreated TB; amongst cases treated under RNTCP; and amongst cases treated under non-RNTCP conditions. Using a Bayesian evidence synthesis framework, we combined these data with current estimates for the TB burden in India to calibrate the transmission model. We simulated the national TB epidemic in the presence and absence of the DOTS programme, measuring lives saved as the difference in TB deaths between these scenarios.

Results

From 1997 to 2016, India’s RNTCP has saved 7.75 million lives (95% Bayesian credible interval 6.29–8.82 million). We estimate that 42% of this impact was due to the ‘indirect’ effects of the RNTCP in averting transmission as well as improving treatment outcomes.

Conclusions

When expanding high-quality TB services, a substantial proportion of overall impact derives from preventive, as well as curative, benefits. Mathematical models, together with sufficient data, can be a helpful tool in estimating the true population impact of major disease control programmes.

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Title: Counting the lives saved by DOTS in India: a model-based approach
Authors: Sandip Mandal
Vineet K. Chadha
Ramanan Laxminarayan
Nimalan Arinaminpathy
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: BMC Medicine / Issue 1/2017
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-017-0809-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Counting the lives saved by DOTS in India: a model-based approach

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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