Cost of Tuberculosis Therapy Directly Observed on Video for Health Departments and Patients in New York City; San Francisco, California; and Rhode Island (2017–2018)

Abstract

Objectives. To assess costs of video and traditional in-person directly observed therapy (DOT) for tuberculosis (TB) treatment to health departments and patients in New York City, Rhode Island, and San Francisco, California. Methods. We collected health department costs for video DOT (VDOT; live and recorded), and in-person DOT (field- and clinic-based). Time–motion surveys estimated provider time and cost. A separate survey collected patient costs. We used a regression model to estimate cost by DOT type. Results. Between August 2017 and June 2018, 343 DOT sessions were captured from 225 patients; 87 completed a survey. Patient costs were lowest for VDOT live ($1.01) and highest for clinic DOT ($34.53). The societal (health department + patient) costs of VDOT live and recorded ($6.65 and $12.64, respectively) were less than field and clinic DOT ($21.40 and $46.11, respectively). VDOT recorded health department cost was not statistically different from field DOT cost in Rhode Island. Conclusions. Among the 4 different modalities, both types of VDOT were associated with lower societal costs when compared with traditional forms of DOT. Public Health Implications. VDOT was associated with lower costs from the societal perspective and may reduce public health costs when TB incidence is high. (Am J Public Health. Published online ahead of print September 17, 2020: e1–e8. https://doi.org/10.2105/AJPH.2020.305877 )

Cost-effectiveness of video-observed therapy for ambulatory management of active tuberculosis during the COVID-19 pandemic in a high-income country

“…This is the first health economic analysis to evaluate the impact of pandemic-related suspension of DOT on the outcomes of TB management, measured as direct medical cost and DALYs, in a high-income country setting. Prior health economics analyses of VOT were limited to the impact on the cost component, either comparing the costs of VOT and DOT (cost-minimization analysis) (Lam et al, 2019;Beeler et al, 2020) or focusing on the cost of VOT (cost-analysis) (Mirsaeidi et al, 2015). The present study is a full-scale health economic analysis, comparing both the cost and effectiveness (measured as DALYs) of management of active TB with VOT versus SAT during the time of pandemic.…”

Tuberculosis Treatment Compliance Under Smartphone-Based Video-Observed Therapy Versus Community-Based Directly Observed Therapy: Protocol for a Cluster Randomized Controlled Trial

“…Previous VOT versus DOT comparative studies [ 10 , 11 ] have been based on an overall assessment, including ordinary percentage of compliance. Our mean cumulative function analysis will determine periods with weak compliance.…”

“…Previous studies reported that in western countries, A-VOT has better patient compliance, cost utility, and acceptability than DOT [ 10 - 13 ]. However, these studies assessed A-VOT according to the number of observations of clinic-based and comprehensive community-based DOT.…”

Development of a Video-Observed Therapy System to Improve Monitoring of Tuberculosis Treatment in Thailand: Mixed-Methods Study

“…For user compliance, the level of use was not high on the patients’ end and low on the observers’ end compared to those in the United States and the United Kingdom [ 15 , 16 ]. Two more system elements would be needed: the audit and notification systems.…”

“…However, A-VOT is a platform on which the patient records and uploads a video to the health service, and the health care personnel review the video later [ 14 ]. Two randomized controlled trials in the United Kingdom and the United States reported that both S-VOT and A-VOT could lower health service costs compared to traditional DOT [ 15 , 16 ].…”