Population Level Health Impact and Cost Effectiveness of New Tuberculosis Vaccines: A Systematic Review
1
Systematic Reviews Network (SRN), Calabar, Nigeria
Popul. Med. 2026;8(Supplement Supplement 1):A3923
ABSTRACT
BACKGROUND:
Tuberculosis remains a leading cause of infectious disease mortality globally, with a disproportionate burden in low-and middle-income countries (LMICs). Bacillus Calmette Guérin (BCG) provides partial protection in children but limited effectiveness in adolescents and adults, motivating the development of novel tuberculosis vaccines. Economic evidence is essential for guiding vaccine investment and policy decisions, yet existing cost effectiveness studies are heterogeneous.
METHODS:
We conducted a systematic review of modelling studies evaluating the cost effectiveness of novel tuberculosis vaccines compared with Bacillus Calmette Guérin or no vaccination. Searches were performed in PubMed, Scopus, Embase, Web of Science, Global Health, and the tuberculosis vaccine preparedness repository for English language studies published between 2014 and 2025. Two reviewers independently screened studies, extracted data, and assessed reporting quality using the CHEERS 2022 checklist. Due to heterogeneity, a narrative synthesis was conducted.
RESULTS:
Ten modelling studies were included, primarily conducted in LMICs, with strong representation from South Africa, India, China, and multi country analyses. Most studies applied dynamic transmission models and adopted health system or societal perspectives. Assumed vaccine efficacy ranged from 17 percent to 80 percent, with duration of protection commonly fixed at 10 years. All studies projected reductions in tuberculosis incidence, mortality, or disability adjusted life years following vaccine introduction. Vaccination strategies targeting adolescents and adults, particularly M72 AS01E like vaccines, consistently generated the greatest health impact and economic value and were frequently cost effective or cost saving. Infant vaccination strategies produced smaller benefits and were cost effective mainly under assumptions of high efficacy and long-lasting protection. Key drivers of cost effectiveness included vaccine efficacy, coverage, price, duration of protection, and baseline tuberculosis burden.
CONCLUSIONS:
Current modelling evidence supports prioritizing adolescent and adult tuberculosis vaccination strategies in LMICs, where health and economic returns are greatest.
Tuberculosis remains a leading cause of infectious disease mortality globally, with a disproportionate burden in low-and middle-income countries (LMICs). Bacillus Calmette Guérin (BCG) provides partial protection in children but limited effectiveness in adolescents and adults, motivating the development of novel tuberculosis vaccines. Economic evidence is essential for guiding vaccine investment and policy decisions, yet existing cost effectiveness studies are heterogeneous.
METHODS:
We conducted a systematic review of modelling studies evaluating the cost effectiveness of novel tuberculosis vaccines compared with Bacillus Calmette Guérin or no vaccination. Searches were performed in PubMed, Scopus, Embase, Web of Science, Global Health, and the tuberculosis vaccine preparedness repository for English language studies published between 2014 and 2025. Two reviewers independently screened studies, extracted data, and assessed reporting quality using the CHEERS 2022 checklist. Due to heterogeneity, a narrative synthesis was conducted.
RESULTS:
Ten modelling studies were included, primarily conducted in LMICs, with strong representation from South Africa, India, China, and multi country analyses. Most studies applied dynamic transmission models and adopted health system or societal perspectives. Assumed vaccine efficacy ranged from 17 percent to 80 percent, with duration of protection commonly fixed at 10 years. All studies projected reductions in tuberculosis incidence, mortality, or disability adjusted life years following vaccine introduction. Vaccination strategies targeting adolescents and adults, particularly M72 AS01E like vaccines, consistently generated the greatest health impact and economic value and were frequently cost effective or cost saving. Infant vaccination strategies produced smaller benefits and were cost effective mainly under assumptions of high efficacy and long-lasting protection. Key drivers of cost effectiveness included vaccine efficacy, coverage, price, duration of protection, and baseline tuberculosis burden.
CONCLUSIONS:
Current modelling evidence supports prioritizing adolescent and adult tuberculosis vaccination strategies in LMICs, where health and economic returns are greatest.
| eISSN: | 2654-1459 |
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