Ensuring adherence and support during treatment of tuberculosis (TB) is a major public health challenge. Digital health technologies could help improve treatment outcomes. We considered their potential cost and impact on treatment for active or latent TB in Brazil.
Decision analysis models simulated two adult cohorts with 1) drug-susceptible active TB, and 2) multidrug-resistant TB, and two cohorts treated with isoniazid for latent TB infection (LTBI): 1) close contacts of persons with active TB, and 2) others newly diagnosed with LTBI. We evaluated four digital support strategies: two different medication monitors, synchronous video-observed therapy (VOT), and two-way short message service (SMS). Comparators were standard directly observed treatment for active TB and self-administered treatment for LTBI. Projected outcomes included costs (2016 US dollars), plus active TB cases and disability-adjusted life years averted among persons with LTBI.
For individuals with active TB, medication monitors and VOT are projected to lead to substantial (up to 58%) cost savings, in addition to alleviating inconvenience and cost to patients of supervised treatment visits. For LTBI treatment, SMS and medication monitors are projected to be the most cost-effective interventions. However, all projections are limited by the scarcity of published estimates of clinical effect for the digital technologies.
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Conflict of interest: N.P. Nsengiyumva reports grants from the European Respiratory Society, during the conduct of the study.
Conflict of interest: B. Mappin-Kasirer has nothing to disclose.
Conflict of interest: O. Oxlade has nothing to disclose.
Conflict of interest: M. Bastos has nothing to disclose.
Conflict of interest: A. Trajman has nothing to disclose.
Conflict of interest: D. Falzon reports a grant from the European Respiratory Society for activities in support of the digital health agenda for the End TB Strategy (funder not involved in decisions made on the content of the current manuscript), during the conduct of the study.
Conflict of interest: K. Schwartzman reports grants from the European Respiratory Society through the Global TB Programme of the World Health Organization, which paid for some research expenses associated with this work, during the conduct of the study.
Support statement: This study was funded by the European Respiratory Society, through a grant to the World Health Organization Global Tuberculosis Programme. Funding information for this article has been deposited with the Crossref Funder Registry.