Cost and Cost-Effectiveness of a Digital Adherence Technology for Tuberculosis Treatment Support in Uganda

Jun 1, 2022, 00:00 AM
10.1016/j.jval.2021.12.002
https://www.valueinhealthjournal.com/article/S1098-3015(21)03230-7/fulltext
Section Title : THEMED SECTION: REMOTE PATIENT MONITORING
Section Order : 924
First Page : 924

Objectives

Digital adherence technologies like 99DOTS are increasingly considered as an alternative to directly observed therapy for tuberculosis (TB) treatment supervision. We evaluated the cost and cost-effectiveness of 99DOTS in a high-TB-burden setting.

Methods

We assessed the costs of implementing 99DOTS in Uganda through a pragmatic, stepped-wedge randomized trial. We measured costs from the health system perspective at 5 of 18 study facilities. Self-reported service activity time data were used to assess activity-based service costs; other costs were captured from budgets and key informant discussions using standardized forms. We estimated costs and effectiveness considering the 8-month study period (“trial specific”) and using a 5-year time horizon (“extended activities”), the latter including a “marginal clinic” expansion scenario that ignored above-site implementation costs. Cost-effectiveness was assessed as cost per patient successfully completing treatment, using Monte Carlo simulation, cost-effectiveness acceptability curves, and sensitivity analyses to evaluate uncertainty and robustness of results.

Results

The total cost of implementing 99DOTS in the “trial-specific” scenario was $99 554 across 18 clinics (range $3771-$6238 per clinic). The cost per treatment success in the “trial-specific” scenario was $355 (range $229-$394), falling to $59 (range $50-$70) assuming “extended activities,” and $49 (range $42-$57) in the “marginal clinic” scenario. The incremental cost-effectiveness of 99DOTS in the “extended-activity” scenario was $355 per incremental treatment success.

Conclusions

Costs and cost-effectiveness of 99DOTS were influenced by the degree to which infrastructure is scaled over time. If sustained and scaled up, 99DOTS can be a cost-effective option for TB treatment adherence support in high-TB-burden settings like Uganda.

https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(21)03230-7&doi=10.1016/j.jval.2021.12.002
HEOR Topics :
  • Cost-comparison, Effectiveness, Utility, Benefit Analysis
  • Digital Health
  • Economic Evaluation
  • Infectious Disease
  • Medical Devices
  • Medical Technologies
  • Pragmatic Trials & Large Sample Trials
  • Specific Diseases & Conditions
  • Study Approaches
Tags :
  • 99DOTS
  • cost analysis
  • cost-effectiveness analysis
  • digital adherence technology
  • tuberculosis
Regions :
  • Africa