Estimating the true disease burden of TB to effectively tackle this public health crisis

May 30, 2018
Lokesh Sharma, Sr Principal, Public Health
Key Highlights

Smoking and tobacco use greatly increases the risk of Pulmonary Tuberculosis (TB), mostly effecting the lungs.  In some countries like India, tobacco use is one of the biggest causes of TB-related deaths. On the occasion of World No-Tobacco day, IQVIA presents an opinion on the criticality of estimating the true disease burden of TB in order to effectively tackle this public health crisis.

Solving public health challenges: ‘First’ step at a time

Albert Einstein once said, “If I were given one hour to save the planet, I would spend 59 minutes defining the problem and one minute resolving it”. To effectively tackle global health challenges, redefining the focus on addressing step one of a typical problem-solving model has assumed critical significance, i.e., Quantifying the extent and size of the challenge. Tuberculosis or TB, especially in LMICs, is a case in point.

TB is the leading infectious disease threat in the world, killing one person every two minutes. It is now widely recognized that a large proportion of TB patients first knock the door of a private sector provider in most LMICs; 50% or more across regions, from Sub-Saharan Africa to India to the far east - Indonesia Vietnam Philippines and Myanmar.  However, the true disease burden of TB in these countries has remained elusive due to lack of aggregated and credible data from the private, especially unorganized sector and non-adherence to the notification mechanism to National TB programs.

Curious case of ‘missing’ TB patients

Globally, 40% of all TB cases are not reported to National TB programs and thus constitute the “missing patient” pool. Policy makers have long been dependent on expert opinions and extrapolations to arrive at the total number of TB cases in the private sector.

While many countries have public-sector dominated models of healthcare, countries which rely on the private sector for treatment and care of TB need to go back to the drawing board and quantify the size and extent of this burden. This will not only aid evidence-backed policy making, optimal resource allocation and targeted interventions, but allow countries to re-evaluate their health priorities.

Counting the uncounted: IQVIA model to estimate true disease burden in the private sector

In the absence of quality surveillance data, sales data of pharmaceuticals in the private sector offered a strong empirical foundation for estimating the disease burden. Leveraging on its proprietary pharma data, IQVIA devised a methodology to compute “TB patient-months” to estimate the real TB load in the private sector in India, a country which is home to the highest TB related deaths globally.

The results were astounding – For the first time, it was known that over 17 million TB patient-months existed in the Indian private sector in 2014, translating to ~2.2 Mn cases of TB, almost twice as many as estimated to be in the public sector. These findings meant huge implications for the National TB program and implored policy makers to rethink strategies to tackle the health crisis.

Resultantly, disease burden estimation using drug sales data was identified as a baseline indicator by India’s ‘National Strategic Plan for TB elimination for TB for 2017-2025’. Latest calculations for 2016 reveal there are 15 Mn patient-months in the private sector.


Source: The number of privately treated tuberculosis cases in India: an estimation from drug sales data – Arinaminpathy, Nimalan et al. The Lancet Infectious Diseases, Volume 16, Issue 11, 1255 - 1260

Leveraging the power to data to drive incremental global health gains

It is widely accepted that to bring about incremental improvements in health outcomes, an integrated approach is the need of the hour. For instance, patients with advanced HIV conditions are at a higher risk of developing opportunistic infections such as TB – Hence knowing the disease burden of HIV is as important in defeating TB as knowing the TB burden.

IQVIA’s disease burden estimation model is versatile in so far as its replication to other diseases and geographies is concerned. Diseases such as HIV/AIDS, diabetes, hypertension – treatment for which have a defined regimen and frequency and typically spread over a long period of time, are ideal use-cases for application of our model. Further, the growing challenge of anti-microbial resistance has necessitated the urgent need to quantify and analyze consumption patterns of antibiotic use. IQVIA’s model could be a handy tool here.


IQVIA has a dedicated public-health focused practice actively engaged with governments, national/international donors, non-governmental organizations (NGOs) and private sector stakeholders to support evidence-based decision making. Our service offerings include Policy and Strategic Planning, Disease Burden Assessment, Research and Analytics including undertaking large community and institutional surveys, Monitoring and Evaluations of Large programs, Procurement and Supply Chain Assessments, Digital Health in Public Health, Public-Private-Partnerships, Support Private sector engagement and Program Implementation. The public health team serves more than 20 countries in the Middle East, South Asia and African region. For more information, please reach out to Mr. Deepak Batra at or Lokesh Sharma at

Please refer to Lancet publication for more details on IQVIA methodology on disease burden estimation in private sector: The number of privately treated tuberculosis cases in India: an estimation from drug sales data – Arinaminpathy, Nimalan et al. The Lancet Infectious Diseases, Volume 16, Issue 11, 1255 – 1260

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