Abstract:

Objective: This study predicted the short-term and long-term epidemiological and economic impacts of the implementation of free tuberculosis (TB) healthcare policy in China, providing scientific evidence for the necessity and feasibility of free TB healthcare policy in China. Methods: Based on the natural history of TB, a TB dynamic model was developed, and two simulation scenarios were simulated to predict the impact of implementing free TB healthcare policy on the trend of TB epidemic, assuming a constant decline rate of annual incidence of TB and a gradually increasing decline rate of annual incidence of TB under other interventions, respectively. The cost-effectiveness, cost-utility, and cost-benefit analyses were conducted to evaluate the social benefits of the government’s investment on free TB healthcare policy. Results: With the free TB health care policy, when the decline rate is maintained at the current level, by 2035, 7584954 latent TB infections (LTBI) and 390333 TB cases can be avoided cumulatively, 195486 successfully treated drug-sensitive TB patients and 62251 drug-resistant TB patients can be increased cumulatively, and 2448501 disability-adjusted life years (DALY) and a social economic value of 273280420000 yuan can be saved. Every extra yuan invested by the government can generate a social economic value of 11.24 yuan. When the decline rate increases, by 2035, 5730438 LTBI and 273441 TB cases can be avoided cumulatively, 179592 successfully treated drug-sensitive TB patients and 49835 drug-resistant TB patients can be increased cumulatively, and 2179554 DALY and a social economic value of 233103460000 yuan can be saved. Every extra yuan invested by the government can generate a social economic value of 12.58 yuan. Conclusion: Implementing free TB healthcare policy can significantly reduce the transmission of TB and has a significant effect on saving social economic cost. These effects are more significant when the annual incidence of TB declines faster. It is recommended that the government shall implement free TB healthcare policy as soon as possible and other interventions to control the spread of TB.

Key words: Tuberculosis, Communicable disease control, Uncompensated care, Models, statistical, Forecasting