The authors built a 1,152-compartment dynamic model of Indian tuberculosis stratified by age, HIV status, body-mass index and socioeconomic status, calibrated to WHO incidence and mortality for 2015 to 2024, and propagated separate pulmonary and extrapulmonary effectiveness posteriors derived from the VPM1002 Phase III trial. Posterior median effectiveness was 42.9% against extrapulmonary disease (95% CrI -5.6 to 69.1) against 14.0% for pulmonary, and three doses per million targeted averted 682 deaths (24 to 1,255) and 9,463 DALYs under 10-year protection. The gross incremental cost-effectiveness ratio was US$329 per DALY averted, rising to US$832 if protection lasts three years.
Why it is interesting: The trial missed its primary composite endpoint, and the model resolves a stronger extrapulmonary signal whose credible interval still includes no effect.