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

Cited 3 time in Web of Science Cited 6 time in Scopus
Authors

Thompson, Ryan R.; Kityamuwesi, Alex; Kuan, Alice; Oyuku, Denis; Tucker, Austin; Ferguson, Olivia; Tinka, Lynn Kunihira; Crowder, Rebecca; Turyahabwe, Stavia; Cattamanchi, Adithya; Dowdy, David W.; Katamba, Achilles; Sohn, Hojoon

Issue Date
2022-06
Publisher
ELSEVIER SCIENCE INC
Citation
VALUE IN HEALTH, Vol.25 No.6, pp.924-930
Abstract
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-TBburden settings like
ISSN
1098-3015
URI
https://hdl.handle.net/10371/201744
DOI
https://doi.org/10.1016/j.jval.2021.12.002
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  • College of Medicine
  • Department of Human Systems Medicine
Research Area 결핵, 국제보건, 에이즈

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