Presentation (CTI)

OBJECTIVES: Treatment of multidrug-resistant TB (MDR TB) with community-based directly observed therapy (CB DOT) is more effective than the health-facility (HF) DOT and is critical for better treatment outcomes. However, it is unclear whether the CB DOT is cost-effective compared to the HF DOT for treating patients with MDR TB in Uganda.
METHODS: We developed and populated a hybrid decision tree-Markov model to assess the cost-effectiveness of treating MDR-TB patients with either CB DOT or HF DOT. Data from the primary quasi-experimental study and published literature were used to parameterize this model. The analysis was conducted from a limited societal perspective, using mean costs and cost per disability-adjusted life year (DALY) averted over a lifetime horizon as the main outcomes. All costs were reported in 2023 US dollars.
RESULTS: In the base-case analysis, the CB DOT was associated with fewer DALYs than the HF DOT (10.90 vs. 13.97). Compared with the HF DOT, the average cost per MDR-TB patient was lower in the CB DOT from the limited societal perspective ($3,576 vs. $4,275). The CB DOT dominated the HF DOT, i.e., for every DALY averted, the CB DOT leads to cost savings of $228. The deterministic sensitivity analysis indicated that the ICER estimates were most sensitive to uncertainties surrounding the probability of death (both strategies) and health system costs.
CONCLUSIONS: The CB DOT is a highly cost-effective strategy for treating patients with MDR TB in Uganda compared to the HF DOT. If implemented, the CB DOT may lead to cost savings, which can be reallocated or invested in improving care for TB and MDR-TB patients.