Cost of failure to reduce TB in Ireland could breach €70m, says RCSI expert

Cost of failure to reduce TB in Ireland could breach €70m, says RCSI expert

Post-TB complications and persistent, related health problems would bring the estimated cost to the State even higher than the €70m figure. Picture: iStock

The cost of missing the World Health Organisation’s (WHO) target for reducing the incidence of tuberculosis (TB) in Ireland could run to over €70m, according to new research.

A study by researchers at the Royal College of Surgeons in Ireland (RSCI) has estimated that a failure to meet the WHO target for the reduction of TB in the Republic will result in 35 additional deaths, and 989 extra cases of the disease by 2035.

They calculated the cost of not meeting the target over the next 13 years could be as high as €70.8m.

Ending TB is a global priority for the WHO, which has set targets as part of its strategy for eliminating the disease.

For low-incidence countries like Ireland, the WHO’s target is a reduction in the incidence of TB by 90% between 2015 and 2035.

However, figures show the annual average decrease in the Republic between 2016 and 2019 was 6.5% — half the rate necessary to meet the target.

Calls for action

The study noted there had been numerous calls in the Republic for the need for more funding for TB prevention and control.

One of the main authors of the study, professor James O’Connell of the RCSI’s department of International health and tropical medicine, said eliminating TB in Ireland would be “challenging”, as it was increasingly concentrated in marginalised groups.

Previous research shows a large proportion of people with TB in many low-incidence countries are recent immigrants from poorer countries with high incidence of the disease.

The latest figures show 45% of people with TB in 2019 were born outside Ireland, while the country of origin was unknown in another 15% of cases.

Researchers observed that Travellers in the Republic have also been disproportionately affected.

Prof O’Connell said the Covid-19 pandemic may have harmed TB control in the Republic with lower testing rates, while the number of cases, particularly involving drug-resistant TB, was likely to increase due to the arrival of people from Ukraine where there are higher levels of the disease.

Ireland, like comparable countries, should be intensifying its TB control efforts.

While Ireland is not dissimilar in how it is positioned to eliminate TB, the study points out that other European countries are funding coordinated programmes to improve their efforts to fight the disease.

Prof O’Connell said investment in the effective intervention was financially justifiable, and recommended the appointment of a national lead for TB elimination in Ireland.

He observed that eliminating TB in low-incidence countries like Ireland requires high levels of wealth, low levels of income inequality, and effective TB programmes and services for those still at risk of the disease.

Prof O’Connell said any programme to eliminate TB needed to focus on tackling poverty and inequality, providing high-quality universal healthcare, and an improved TB programme, including a reduction in diagnostic delays and improved contact management and outbreak response.

"If Ireland is to meet the end TB target, 51 of the 56 cases per million of TB notified in the year of 2019 would have to be prevented,” said Prof O’Connell. He added: 

What is clear even from this analysis is that continuing at the current rate without intervention is a costly choice.

The study, which is published in the Irish Journal of Medical Science, said the true costs could be much higher that the figure of €70.8m if one included the cost of prolonged symptoms prior to diagnosis, socio-economic consequences, and post-TB complications such as chronic lung disease, and psychological ill health.

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