Open AccessCost savings associated with video directly observed therapy for treatment of tuberculosis
Author(s) -
Chee Kin Lam,
Keith Fluegge,
Michelle Macaraig,
Joseph Burzynski
Publication year - 2019
Publication title -
the international journal of tuberculosis and lung disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.103
H-Index - 110
eISSN - 1815-7920
pISSN - 1027-3719
DOI - 10.5588/ijtld.18.0625
Subject(s) - medicine , directly observed therapy , session (web analytics) , activity based costing , tuberculosis , statistics , mathematics , computer science , economics , accounting , pathology , world wide web
OBJECTIVE: To calculate the per-session and annual direct program costs to implement directly observed therapy (DOT) for tuberculosis treatment and to conduct a cost attribution analysis under varying proportions of DOT utilization for four DOT types. DESIGN: Program data covering the study period from September 2014 to August 2015 in New York City (NYC) were used to conduct a retrospective bottom-up micro-costing economic evaluation. For each DOT type, potential per-session and annual program savings were estimated as the cost averted by adopting a uniform distribution of DOT alternatives. Sensitivity analyses explored aggregate cost impacts of unequal distributions. RESULTS: There was a total of 38 035 unique DOT visits, of which 12 002 (32%) were clinic-based (CDOT); 15 483 (41%) were field-based (FDOT); 7185 (19%) were live-video (LVDOT); and 3365 (9%) were recorded-video (RVDOT). The per-session direct costs (in 2016 $US) for DOT services delivered during the study period were $8.46 for CDOT; $19.83 for FDOT; $6.54 for LVDOT; and $5.35 for RVDOT. Sensitivity analyses supported the main findings. CONCLUSIONS: Significant cost savings were estimated with increased utilization of VDOT. Assuming equivalent treatment adherence, duration, completion, and adverse events across DOT types, RVDOT was the modality that most minimized cost.