Abstract Background Tuberculosis remains one of the leading infectious causes of death and disability worldwide, imposing a disproportionate economic-burden on low- and middle-income countries (LMICs). Quantifying this burden in macroeconomic terms is critical for health-policy prioritization. We aimed to estimate the global, regional, and national economic consequences of TB using a value-of-lost-welfare (VLW) approach based on disability-adjusted life years (DALYs). Methods Disability-adjusted life-year data for TB were obtained from the Global Burden of Disease 2023 framework. Country-specific gross domestic product (GDP, adjusted for purchasing-power-parity PPP) data were retrieved from the World Bank World Development Indicators. DALY and GDP data were combined to estimate macroeconomic losses using a VLW-model in which welfare loss equals the product of DALYs and the value of a statistical life-year (VSLY), expressed in 2017 international USDs adjusted for PPP. The proportional economic-burden was reported as VLW/GDP (%) to reflect each nation’s welfare loss as a share of economic-output. Cross-country inequality was quantified using percentile ratios and Pareto concentration indices. Results In 2023, tuberculosis accounted for 43. 6 million DALYs globally, corresponding to an estimated US 1. 35 trillion (95% UI 1. 10-1. 63) in welfare losses, equivalent to 0. 83 % of the world’s GDP. South Asia and sub-Saharan-Africa together contributed 68 % of total global losses. The top five countries—India (US 377 billion; 28. 0 %), Indonesia (US 96 billion; 7. 2 %), Democratic Republic of the Congo (US 79 billion; 5. 9 %), Pakistan (US 78 billion; 5. 8 %), and Nigeria (US 77 billion; 5. 8 %) —accounted for more than half of global TB-related economic losses. Twenty-two countries represented 80 % of the total burden. The median per-country VLW/GDP share was 0. 11 % (IQR 0. 02-0. 58 %), ranging from 2 % in several high-incidence African and Asian nations to 0. 01 % in most high-income countries. Regions with the highest welfare-loss intensity included Southeast Asia, Western Pacific, and Eastern Africa, reflecting both high disease prevalence and younger affected populations contributing to productivity loss. Conclusions The global economic toll of tuberculosis remains immense and unevenly distributed. When expressed in welfare-adjusted terms, TB eliminates an estimated 0. 8 % of the world’s economic-potential annually, with nearly three-quarters of losses concentrated in LMICs. Integrating VLW into TB control strategies highlights that investments in early-detection and treatment yield not only health but also measurable economic returns. These findings underscore the need for sustained financial commitment to the WHO End TB Strategy and for national programs to frame TB elimination as an economic imperative rather than solely a health objective. This abstract is funded by: NA
Singh et al. (Fri,) studied this question.