Tuberculosis in the Western Pacific Region: Estimating the Burden of Disease and Return on Investment 2020-2030

Background: We aimed to estimate the disease burden of Tuberculosis (TB) and return on investment of TB care in the Western Pacific Region (WPR) until 2030. Methods: We projected the TB epidemic in Viet Nam and Lao People’s Democratic Republic (PDR) for the years 2020-30 with TIME Impact model under various scenarios: no TB care; baseline (TB care continues at current levels); and several interventions. We extracted literature results for China and the Philippines to estimate region-level incidence and deaths. We used a Solow model to estimate the return on investment of TB care and interventions. Findings: In the baseline scenario, TB incidence in the WPR decreased from 95·2/100,000/year (2019) to 91·5/100,000/year (2030), and TB deaths from 79,000/year (2019) to 68,100/year (2030). Active case finding (ACF) strategies (screening people not seeking care for respiratory symptoms) were the most effective single intervention. A combination intervention resulted in TB incidence of 43·9/100,000/year and 18,000 TB deaths in 2030. Estimated return on investment (2020-2030) for TB care in Viet Nam and Lao PDR ranged US$4 to US$49 per dollar spent, Additional interventions brought returns of up to US$2·7 per dollar spent. Interpretation: TB incidence will only modestly decrease in the WPR without additional interventions. Intervention strategies that include ACF can reduce TB burden, but achieving the End TB incidence and mortality targets will be difficult without new transformational tools. TB care can bring a multiple-fold return on investment. Funding Statement: This study was funded by the World Health Organization Western Pacific Regional Office and the Swiss National Science Foundation (grant 163878). Declaration of Interests: We declare no competing interests.