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Cost and Cost-Effectiveness of a Digital Adherence Technology for Tuberculosis Treatment Support in Uganda
DC Field | Value | Language |
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dc.contributor.author | Thompson, Ryan R. | - |
dc.contributor.author | Kityamuwesi, Alex | - |
dc.contributor.author | Kuan, Alice | - |
dc.contributor.author | Oyuku, Denis | - |
dc.contributor.author | Tucker, Austin | - |
dc.contributor.author | Ferguson, Olivia | - |
dc.contributor.author | Tinka, Lynn Kunihira | - |
dc.contributor.author | Crowder, Rebecca | - |
dc.contributor.author | Turyahabwe, Stavia | - |
dc.contributor.author | Cattamanchi, Adithya | - |
dc.contributor.author | Dowdy, David W. | - |
dc.contributor.author | Katamba, Achilles | - |
dc.contributor.author | Sohn, Hojoon | - |
dc.date.accessioned | 2024-05-14T04:34:10Z | - |
dc.date.available | 2024-05-14T04:34:10Z | - |
dc.date.created | 2024-05-14 | - |
dc.date.issued | 2022-06 | - |
dc.identifier.citation | VALUE IN HEALTH, Vol.25 No.6, pp.924-930 | - |
dc.identifier.issn | 1098-3015 | - |
dc.identifier.uri | https://hdl.handle.net/10371/201744 | - |
dc.description.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 | - |
dc.language | 영어 | - |
dc.publisher | ELSEVIER SCIENCE INC | - |
dc.title | Cost and Cost-Effectiveness of a Digital Adherence Technology for Tuberculosis Treatment Support in Uganda | - |
dc.type | Article | - |
dc.identifier.doi | 10.1016/j.jval.2021.12.002 | - |
dc.citation.journaltitle | VALUE IN HEALTH | - |
dc.identifier.wosid | 000838560100005 | - |
dc.identifier.scopusid | 2-s2.0-85122303372 | - |
dc.citation.endpage | 930 | - |
dc.citation.number | 6 | - |
dc.citation.startpage | 924 | - |
dc.citation.volume | 25 | - |
dc.description.isOpenAccess | Y | - |
dc.contributor.affiliatedAuthor | Sohn, Hojoon | - |
dc.type.docType | Article | - |
dc.description.journalClass | 1 | - |
dc.subject.keywordAuthor | 99DOTS | - |
dc.subject.keywordAuthor | cost analysis | - |
dc.subject.keywordAuthor | cost-effectiveness analysis | - |
dc.subject.keywordAuthor | digital adherence technology | - |
dc.subject.keywordAuthor | tuberculosis | - |
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