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

ABSTRACT: Objective: The coronavirus 2019 (COVID-19) pandemic caused suspension of directly observed therapy (DOT) for patients with active tuberculosis (TB). This study aimed to estimate the outcomes of pandemic-related DOT suspension and the cost-effectiveness of video-observed therapy (VOT) duri...

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Autores principales:	Ginenus Fekadu, Xinchan Jiang, Jiaqi Yao, Joyce H.S. You
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Video-observed therapy COVID-19 pandemic Tuberculosis Cost-effectiveness High income Infectious and parasitic diseases RC109-216
Acceso en línea:	https://doaj.org/article/0f3de7c2d3b64db2888f38d3d39617a8
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spelling	oai:doaj.org-article:0f3de7c2d3b64db2888f38d3d39617a82021-11-14T04:31:15ZCost-effectiveness of video-observed therapy for ambulatory management of active tuberculosis during the COVID-19 pandemic in a high-income country1201-971210.1016/j.ijid.2021.10.029https://doaj.org/article/0f3de7c2d3b64db2888f38d3d39617a82021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S1201971221008171https://doaj.org/toc/1201-9712ABSTRACT: Objective: The coronavirus 2019 (COVID-19) pandemic caused suspension of directly observed therapy (DOT) for patients with active tuberculosis (TB). This study aimed to estimate the outcomes of pandemic-related DOT suspension and the cost-effectiveness of video-observed therapy (VOT) during the pandemic. Methods: A decision-analytic model was constructed to project outcomes of adult patients with active TB from the perspective of a US healthcare provider. Two model-based analyses were conducted: (1) before (with DOT) and during [with self-administered therapy (SAT)] the pandemic; and (2) VOT vs SAT during the pandemic. The primary outcome measures were direct medical costs and disability-adjusted life years (DALYs). Results: In the base-case analysis, care during the pandemic (with SAT) increased the cost (by US$285 per patient) and DALYs (by 0.2155 per patient) in comparison with DOT. Care with VOT reduced DALYs (by 0.4870) and costs (by US$1797) in comparison with SAT. On probabilistic sensitivity analysis, care during the pandemic (with SAT) increased DALYs in 100% of 10,000 simulations, and increased costs in 55.52% of instances. Care with VOT reduced DALYs and costs in 99.7% and 68.79% of instances, respectively. The probability of VOT being cost-effective was 99.4% at the willingness-to-pay threshold of 50,000 US$/DALY. Conclusion: Suspension of DOT during the COVID-19 pandemic worsened treatment outcomes. VOT was found to be a cost-effective option for active TB care in an outpatient setting.Ginenus FekaduXinchan JiangJiaqi YaoJoyce H.S. YouElsevierarticleVideo-observed therapyCOVID-19 pandemicTuberculosisCost-effectivenessHigh incomeInfectious and parasitic diseasesRC109-216ENInternational Journal of Infectious Diseases, Vol 113, Iss , Pp 271-278 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Video-observed therapy COVID-19 pandemic Tuberculosis Cost-effectiveness High income Infectious and parasitic diseases RC109-216
spellingShingle	Video-observed therapy COVID-19 pandemic Tuberculosis Cost-effectiveness High income Infectious and parasitic diseases RC109-216 Ginenus Fekadu Xinchan Jiang Jiaqi Yao Joyce H.S. You Cost-effectiveness of video-observed therapy for ambulatory management of active tuberculosis during the COVID-19 pandemic in a high-income country
description	ABSTRACT: Objective: The coronavirus 2019 (COVID-19) pandemic caused suspension of directly observed therapy (DOT) for patients with active tuberculosis (TB). This study aimed to estimate the outcomes of pandemic-related DOT suspension and the cost-effectiveness of video-observed therapy (VOT) during the pandemic. Methods: A decision-analytic model was constructed to project outcomes of adult patients with active TB from the perspective of a US healthcare provider. Two model-based analyses were conducted: (1) before (with DOT) and during [with self-administered therapy (SAT)] the pandemic; and (2) VOT vs SAT during the pandemic. The primary outcome measures were direct medical costs and disability-adjusted life years (DALYs). Results: In the base-case analysis, care during the pandemic (with SAT) increased the cost (by US$285 per patient) and DALYs (by 0.2155 per patient) in comparison with DOT. Care with VOT reduced DALYs (by 0.4870) and costs (by US$1797) in comparison with SAT. On probabilistic sensitivity analysis, care during the pandemic (with SAT) increased DALYs in 100% of 10,000 simulations, and increased costs in 55.52% of instances. Care with VOT reduced DALYs and costs in 99.7% and 68.79% of instances, respectively. The probability of VOT being cost-effective was 99.4% at the willingness-to-pay threshold of 50,000 US$/DALY. Conclusion: Suspension of DOT during the COVID-19 pandemic worsened treatment outcomes. VOT was found to be a cost-effective option for active TB care in an outpatient setting.
format	article
author	Ginenus Fekadu Xinchan Jiang Jiaqi Yao Joyce H.S. You
author_facet	Ginenus Fekadu Xinchan Jiang Jiaqi Yao Joyce H.S. You
author_sort	Ginenus Fekadu
title	Cost-effectiveness of video-observed therapy for ambulatory management of active tuberculosis during the COVID-19 pandemic in a high-income country
title_short	Cost-effectiveness of video-observed therapy for ambulatory management of active tuberculosis during the COVID-19 pandemic in a high-income country
title_full	Cost-effectiveness of video-observed therapy for ambulatory management of active tuberculosis during the COVID-19 pandemic in a high-income country
title_fullStr	Cost-effectiveness of video-observed therapy for ambulatory management of active tuberculosis during the COVID-19 pandemic in a high-income country
title_full_unstemmed	Cost-effectiveness of video-observed therapy for ambulatory management of active tuberculosis during the COVID-19 pandemic in a high-income country
title_sort	cost-effectiveness of video-observed therapy for ambulatory management of active tuberculosis during the covid-19 pandemic in a high-income country
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/0f3de7c2d3b64db2888f38d3d39617a8
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Cost-effectiveness of video-observed therapy for ambulatory management of active tuberculosis during the COVID-19 pandemic in a high-income country

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