Economic costs of TB and HIV in high-TB-burden countries.

INTRODUCTION: Tuberculosis (TB) remains a significant health burden in 25 low- and middle-income countries. Despite TB being more cost-effective to prevent and treat its funding is disproportionately lower than that of HIV. This study aims to assess the economic costs of TB versus HIV and evaluate the returns on investment in TB prevention compared to HIV. METHODS: The study uses a microfoundations behavioural model to estimate the economic costs of TB and HIV on households and the economy. We combine data from the WHO Global Tuberculosis Report, the Institute for Health Metrics and Evaluation's Global Burden of Disease dataset and Demographic Household Surveys among others. The analysis accounts for lost earnings and healthcare expenses in the short and long term. RESULTS: The findings indicate that active TB cases result in significant economic losses, with US13. 7 billion in current annual losses, US17. 2 billion in future losses and US5. 7 billion in medical expenses, for a total of US36. 6 billion. In contrast, HIV causes US5. 5 billion in current losses, US20. 9 billion in future losses and leads to medical expenses of US6. 1 billion for a total of US32. 5 billion. There is substantial across-country heterogeneity in the composition of these costs. CONCLUSION: The economic impacts of TB are at least as large as those of HIV, with higher returns on investment in TB prevention. These results advocate for increased funding for TB relative to funding for HIV in these countries because the returns to incremental funding for TB are greater than those for HIV at current funding levels.