Modelling approaches for tuberculosis: are they realistic?

The Article by Nicolas Menzies and colleagues (November, 2016), based on a modelling approach, concludes that most tuberculosis control interventions in South Africa, China, and India are highly cost-effective. In this regard, I have a different viewpoint.

Such modelling approaches are useful in countries where the data are reliable and predictions are precise. However, when applied to low-income or high-burden countries they face a fundamental problem that the reality substantially differs from the basic assumptions. The models rarely account for political determinants such as investments in the health sector, political disruptions, migration, poverty, and poor regulation of the private sector including private pharmacies, which are at the root of existing tuberculosis and emerging anti-tuberculosis drug resistance in the world.