Cost-Effectiveness of a Medication Event Monitoring System for Tuberculosis Management in Morocco

Abstract

Background Poor adherence to tuberculosis (TB) treatment can result in community transmission and drug resistance. Digital health technologies have been used to enhance adherence to TB medication for proper management, but the cost-effectiveness of this approach remains unclear.Methods We used the real data from the study conducted from April 2014 to December 2020 in Morocco to enhance the adherence to drug-susceptible TB treatment using a smart pillbox with a web-based medication monitoring system, called Medication Event Monitoring Systems (MEMS). We applied a Markov model adding Multi-drug resistant (MDR) TB to evaluate the costs and cost-effectiveness of MEMS, compared to the standard of care (modified directly observed treatment and intervention) from the health perspective. The primary outcome was the incremental cost-effectiveness ratio (ICER) per disability adjusted life-year (DALY) averted. We also performed two-way sensitive analysis between treatment success rate of MEMS and standard of care. Results The average total per-patient health system costs for treating a new TB patient under MEMS versus standard of care were $398.7 and $155.7, respectively. The MEMS strategy would reduce the number of drug-susceptible TB cases by 0.17 and MDR-TB cases by 0.01 per patient over five years. The ICER of MEMS was $434/DALY averted relative to standard of care, and was most susceptible to the TB treatment success rate of both strategies followed by the managing cost of MEMS.Conclusion MEMS is considered cost-effective for managing infectious active TB in Morocco.

Mapping the effectiveness of the community tuberculosis care programme: A systematic review

“…They consisted of eleven RCTs(14,15,24,16–23), four cluster randomised control trials(25–28), nineteen seventeen cohort studies(29,30,39–47,31–38), one records reviews(48) and one quasi trial(49). All thirty-six had a control group and provided estimates of effect: Eleven evaluated community health care worker direct observation therapy (CHWDOT)(24,27,31,38)(14,19,25,26,29,33,39), nine evaluated family direct observation therapy (FDOT) (21–23,28,37,40,41,48–50), five evaluated short Message Service reminders (SMS) (15–18,51,52), six examined video observed therapy(VOT) (20,32,34,35,43,44) and five examined the electronic medication monitors (EMM) (30,42,45–47) See Fig 2 . Substantive descriptions of the included studies including intervention evaluated can be seen in Table 2 and 3…”

“…(30) Another study conducted in Morocco evaluating the costs and cost-effectiveness of a Medication Event Monitoring System (using a smart pillbox with a web-based medication monitoring system)for Tuberculosis Management against standard of care (SoC) have shown the ICER of $434/DALY averted for managing drug-susceptible TB patients by MEMS relative to SoC thus MEMS is considered cost-effective in Morocco. (47)…”

“…The thirty-six included studies were published between 2000 and 2021. They consisted of eleven RCTs (14,15,24,(16)(17)(18)(19)(20)(21)(22)(23), four cluster randomised control trials (25)(26)(27)(28), nineteen seventeen cohort studies (29,30,(39)(40)(41)(42)(43)(44)(45)(46)(47)(31)(32)(33)(34)(35)(36)(37)(38), one records reviews (48) and one quasi trial (49). All thirty-six had a control group and provided estimates of effect: Eleven evaluated community health care worker direct observation therapy (CHWDOT) (24,27,31,38) (14,19,25,26,29,33,39), nine evaluated family direct observat...…”

Effect of implementing digital adherence technologies on the use of health care providers’ time and the human resource cost of tuberculosis treatment adherence support in Ethiopia

“…Studies evaluating the cost and cost-effectiveness of digital adherence technologies for tuberculosis treatment reported to date have not directly measured the amount of time spent by healthcare workers on adherence support and compared this time between a SoC and intervention arm, however the cost of staff care have been included [10][11][12]. These studies found DATs to be more expensive than SoC and with mixed evidence of treatment effect.…”