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Cost of digital technologies and family-observed DOT for a shorter MDR-TB regimen : a modelling study in Ethiopia, India and Uganda
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Rosu, Laura, Madan, Jason, Bronson, Gay, Nidoi, Jasper, Tefera, Mamo G., Malaisamy, Muniyandi, Squire, Bertel S. and Worrall, Eve (2023) Cost of digital technologies and family-observed DOT for a shorter MDR-TB regimen : a modelling study in Ethiopia, India and Uganda. BMC Health Services Research, 23 (1). 1275. doi:10.1186/s12913-023-10295-z ISSN 1472-6963.
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Official URL: http://doi.org/10.1186/s12913-023-10295-z
Abstract
Background: In 2017, the WHO recommended the use of digital technologies, such as medication monitors and video observed treatment (VOT), for directly observed treatment (DOT) of drug-susceptible TB. The WHO’s 2020 guidelines extended these recommendations to multidrug-resistant tuberculosis (MDR-TB), based on low evidence. The impact of COVID on health systems and patients underscored the need to use digital technologies in the management of MDR-TB. Methods: A decision-tree model was developed to explore the costs of several potential DOT alternatives: VOT, 99DOTS (Directly-observed Treatment, Short-course) and family-observed DOT. Assuming a 9-month, all-oral regimen (as evaluated within the STREAM trial), we constructed base-case cost models for the standard-of-care DOTs in Ethiopia, India, and Uganda, as well as for the three alternative DOT approaches. The models were populated with STREAM Stage 2 clinical trial outcome and cost data, supplemented with market prices data for the digital DOT strategies. Sensitivity analyses were conducted on key parameters. Results: Modelling suggested that the standard-of-care DOT approach is the most expensive DOT strategy from a societal perspective in all three countries evaluated (Ethiopia, India, Uganda), with considerable direct- and indirect-costs incurred by patients. The second most expensive DOT approach is VOT, with high health-system costs, largely caused by up-front technology expenditure. Each of VOT, 99DOTS and family-observed DOT would reduce by more than 90% patients’ direct and indirect costs compared to standard of care DOT. Results were robust to the sensitivity analyses. Conclusions: While data on the costs and efficacy of alternative DOT approaches in the context of shorter MDR-TB treatment is limited, our modelling suggests alternative DOT approaches can significantly reduce patient costs in all three countries. Health system costs are higher for VOT and lower for 99DOTS and family-observed therapy when compared to standard of care DOT, as low smartphone penetration and internet availability requires the VOT health system to fund the cost of making them available to patients.
Item Type: | Journal Article | ||||||||||||||||||
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Subjects: | Q Science > QR Microbiology T Technology > TK Electrical engineering. Electronics Nuclear engineering |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||||||||||||||
SWORD Depositor: | Library Publications Router | ||||||||||||||||||
Library of Congress Subject Headings (LCSH): | Tuberculosis, Digital electronics, Multidrug-resistant tuberculosis | ||||||||||||||||||
Journal or Publication Title: | BMC Health Services Research | ||||||||||||||||||
Publisher: | BioMed Central | ||||||||||||||||||
ISSN: | 1472-6963 | ||||||||||||||||||
Official Date: | 18 November 2023 | ||||||||||||||||||
Dates: |
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Volume: | 23 | ||||||||||||||||||
Number: | 1 | ||||||||||||||||||
Article Number: | 1275 | ||||||||||||||||||
DOI: | 10.1186/s12913-023-10295-z | ||||||||||||||||||
Status: | Peer Reviewed | ||||||||||||||||||
Publication Status: | Published | ||||||||||||||||||
Re-use Statement: | ** From Springer Nature via Jisc Publications Router ** History: received 01-03-2023; registration 07-11-2023; accepted 07-11-2023; epub 18-11-2023; online 18-11-2023; collection 12-2023. ** Licence for this article: http://creativecommons.org/licenses/by/4.0/ ** Acknowledgements: Not applicable. | ||||||||||||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||||||||||||
Date of first compliant deposit: | 5 December 2023 | ||||||||||||||||||
Date of first compliant Open Access: | 5 December 2023 | ||||||||||||||||||
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