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

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

doi:10.1016/j.jval.2021.12.002

Cited by 10 publications

(11 citation statements)

References 15 publications

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“…Our study complements this work by carefully documenting capital and operating expenditures, allowing for better planning and decisions by TB treatment programs (31). Our cost estimates for 99DOTS are similar to those from other TB programs which used this technology (15, 32). A recent study from the USA estimated that VOT was cheaper than in-person DOT provided by health care staff (25), for both the health care system and for persons with TB and their families.…”

Section: Discussionsupporting

confidence: 63%

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Costs of digital adherence technologies for tuberculosis treatment support

Nsengiyumva

Khan²,

Gler³

et al. 2023

Preprint

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Digital adherence technologies (DATs) are increasingly used for tuberculosis (TB) adherence support, but information about their costs remains limited. We used microcosting to estimate health system costs (in 2022 US dollars) of 99DOTS pill sleeves and video-observed treatment (VOT), implemented in demonstration projects during 2018-21. Local cost estimates for standard directly observed treatment (DOT) were also obtained. The estimated per-person costs of 99DOTS for drug-sensitive (DS-) TB were $98, $106, and $174 in Bangladesh (n=719), the Philippines (n=396), and Tanzania (n=976) respectively. The estimated per-person costs of VOT were $1 154, $304, $457, and $661 in Haiti (n=87 DS-TB), Moldova (n=173 DS-TB), Moldova (n=135 drug-resistant [DR]-TB) and the Philippines (n=110 DR-TB) respectively. Health system costs of 99DOTS may be similar to or cheaper than standard DOT. VOT is considerably more expensive; labor cost offsets and/or economies of scale may yield savings relative to standard DOT in some settings.

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Section: Discussionsupporting

confidence: 63%

“…Seven other implementation projects pursued separate costing analyses, some of which have been published elsewhere e.g. the Ugandan project (15). Top-down costing used total amounts spent for DAT platform/infrastructure, systems/data management and technical support, and training activities.…”

Section: Cost Analysismentioning

confidence: 99%

Costs of digital adherence technologies for tuberculosis treatment support

Nsengiyumva

Khan²,

Gler³

et al. 2023

Preprint

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“…Studies evaluating the cost and cost-effectiveness of digital adherence technologies for tuberculosis treatment reported to date have not directly measured the amount of time spent by healthcare workers on adherence support and compared this time between a SoC and intervention arm, however the cost of staff care have been included [10][11][12]. These studies found DATs to be more expensive than SoC and with mixed evidence of treatment effect.…”

Section: Discussionmentioning

confidence: 99%

Effect of implementing digital adherence technologies on the use of health care providers’ time and the human resource cost of tuberculosis treatment adherence support in Ethiopia

Belachew,

Sahile,

Gadissa

et al. 2024

Preprint

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Background. The management of human resources for health is a key priority for resource constrained health systems. Digital adherence technologies (DATs) for treatment support offer an opportunity to reorganise existing healthcare worker workload. Historically, tuberculosis treatment services involved directly observed treatment with frequent patient visits to the clinic for treatment adherence support. More recently, digital technologies have offered an option for the digital monitoring of treatment adherence and remote support. The aim of this study was to determine how health care workers use their time following the implementation of digital adherence support, and the human resource cost of tuberculosis treatment adherence support. Methods. As part of the ASCENT three-arm cluster randomised trial of DATs for tuberculosis treatment support, we conducted time-and-motion studies in 15 of 78 ASCENT-trial health facilities for six-weeks. Healthcare workers recorded time spent on direct patient care and in-person adherence monitoring for 10 patients, as well as time spent on above-service activities. Total time use was calculated by multiplying time spent per visit by number of patient visits at the facility for six weeks and adding above-service time. In a facility-level analysis, we used negative binomial regression models to investigate associations between total time use and facility-level factors. Findings. HCWs spent 4% (126/2892) of time in minutes on in-person adherence monitoring in the Labels, compared to 7% (206/3126) in the Pillbox and 13% (587/4673) in the standard-of-care study arms. More time was spent on above-service activities in the standard-of-care (2360 minutes [SD:1951]) compared to the DAT arms (Pillbox: 2057min [SD:1570]; Labels: 2261min [SD:1360]). After adjusting for facility workload and number of people lost-to-follow-up, we did not find sufficient evidence of a difference in the human resource costs between the study arms (Labels IRR (95%CI): 0.71 (0.33; 1.52); Pillbox (95% CI) 0.71 (0.33; 1.52)). Conclusion. We found a small, although not statistically significant reduction, in human resource costs in the facilities where DATs were implemented. We observed changes in how healthcare workers spent their time, including a shift towards fewer health facility visits but more time spent on in-person adherence support. Further work is ongoing to assess the implications for the cost-effectiveness of the interventions.

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“…digital pills and data support infrastructure) as well as person power (for maintenance, interpretation of data). While activation costs of these systems may be high, previous work in other countries suggests that a gradual scale-up of technology and personnel infrastructure needed to manage these systems may ultimately make them cost effective in the long term [ 21 , 22 ]. Despite these concerns, earlier work has demonstrated that the costs of deploying a DPS for TB ATT adherence may ultimately be cost effective when considering costs associated with monitoring and managing DOT therapy in both WHO recommended seven and 3 day DOT models [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Formative acceptance of ingestible biosensors to measure adherence to TB medications

et al. 2022

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Background Tuberculosis (TB) represents a significant public health threat in India. Adherence to antitubercular therapy (ATT) is the key to reducing the burden of this infectious disease. Suboptimal adherence to ATT and lack of demonstrated feasibility of current strategies for monitoring ATT adherence highlights the need for alternative adherence monitoring systems. Methods A quantitative survey was conducted to assess the acceptance of and willingness to use a digital pill system (DPS) as a tool for monitoring ATT adherence among stakeholders directly involved in the management of patients with TB in India. Participants reviewed a video explaining the DPS and completed a survey, which covered sociodemographics, degree of involvement with TB patients, initial impressions of the DPS, and perceived challenges for deploying the technology in India. Participants were also asked to interpret mock DPS adherence data. Results The mean age was 34.3 (SD = 7.3), and participants (N = 50) were predominantly male (70%). The sample comprised internists (52%) and pulmonologists (30%), with a median of 4 years’ experience (IQR 3, 6) in the management of TB patients. No participants had previously used a DPS, but some reported prior awareness of the technology (22%). Most reported that they would recommend use of a DPS to patients on ATT (76%), and that they would use a DPS in both the intensive and continuation phases of TB management (64%). The majority viewed the DPS (82%) as a useful alternative to directly observed therapy-short course (DOTS), particularly given the ongoing COVID-19 pandemic. Participants reported that a DPS would be most effective in patients at risk of nonadherence (64%), as well as those with past nonadherence (64%). Perceived barriers to DPS implementation included lack of patient willingness (92%), cost (86%), and infrastructure constraints (66%). The majority of participants were able to accurately interpret patterns of adherence (80%), suboptimal adherence (90%), and frank nonadherence (82%) when provided with mock DPS data. Conclusions DPS are viewed as an acceptable, feasible, and useful technology for monitoring ATT adherence by stakeholders directly involved in TB management. Future investigations should explore patient acceptance of DPS and pilot demonstration of the system in the TB context.

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

Cited by 10 publications

References 15 publications

Costs of digital adherence technologies for tuberculosis treatment support

Costs of digital adherence technologies for tuberculosis treatment support

Effect of implementing digital adherence technologies on the use of health care providers’ time and the human resource cost of tuberculosis treatment adherence support in Ethiopia

Formative acceptance of ingestible biosensors to measure adherence to TB medications

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