Health economic evaluations of tuberculosis control in Indonesia

Tuberculosis (TB) was the leading cause of death due to infectious diseases. In Indonesia, TB incidence and mortality are still very high. Immediate steps to scale-up preventive, diagnostic, and treatment services for TB, specifically among hard-to-reach populations, were prioritised. This thesis covers health economics of TB control programs, focusing on both TB prevention and TB treatment. For TB prevention, this thesis concludes that a universal BCG vaccination strategy is the most cost-effective strategy in a high-incidence country such as Indonesia. Therefore, the vaccination is warranted to be scaled up, especially in outreach regions throughout the country where coverage is generally lower than in urban areas. Two strategies, combining various levels of home vaccination and a less restrictive open vial strategy, were shown to be cost-effective with increased coverage of BCG vaccination in these areas. For treatment, this thesis highlighted that shortened treatment regimens on drug-resistant TB (including MDR TB and RR TB) are cost-effective and provide potential benefits to better control the TB epidemic in Indonesia.