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

Fekadu, Ginenus; Jiang, Xiong‐Jie; Yao, Jiaqi; You, Joyce H. S.

doi:10.1016/j.ijid.2021.10.029

Cited by 24 publications

(22 citation statements)

References 23 publications

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“…However, their compliance did gradually dwindle over time owing to an increase in the number of COVID-19 cases. This was mirrored in many other countries where the level of tuberculosis care decreased due to the burden of COVID-19 [ 8 , 16 , 17 ].…”

Section: Discussionmentioning

confidence: 94%

“…The health care system had struggled to cope with COVID-19, resulting in nonemergency services, including directly observed therapy (DOT) for tuberculosis, being de-emphasized [ 2 , 3 ]. This occurred in addition to DOT being widely criticized for its sloppiness [ 4 - 8 ]. Under this constraint, a video-observed therapy (VOT) system, or more specifically, the Thai VOT (TH VOT) system, was developed to replace DOT.…”

Section: Introductionmentioning

confidence: 99%

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Video-Observed Therapy With a Notification System for Improving the Monitoring of Tuberculosis Treatment in Thailand: Usability Study

Kumwichar¹,

Chongsuvivatwong²,

Prappre³

2022

JMIR Form Res

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Background In Thailand, the health care system has struggled to cope with COVID-19, resulting in directly observed therapy for tuberculosis being de-emphasized. A video-observed therapy (VOT) system, or more specifically, the Thai VOT (TH VOT) system, was developed to replace directly observed therapy. According to the pilot study, the system needed notifications to improve usability and user compliance. The updated version of the TH VOT system thus enabled LINE (Line Corporation) notifications. Objective This study aimed to reassess users’ compliance with and the usability of the updated TH VOT system. Methods This study was conducted in the Hat Yai and Mueang Songkhla districts in Songkhla Province, Southern Thailand, from September 18 to December 1, 2021. The system was used by not only patients with tuberculosis but also tuberculosis staff, who acted as observers in primary health care settings. Some of the observers used the simulated VOT system instead of the actual system due to the lack of participating patients in their jurisdiction. After 30 days of using the system, VOT session records were analyzed to determine the compliance of the patients and observers. The User Experience Questionnaire was administered to reassess the usability of the system and compare the ratings of the participants with the general benchmark scores of the User Experience Questionnaire. The results were summarized to reveal the degree of user compliance and usability in the following three groups: the patients, actual VOT observers, and simulated VOT observers. Results Of the 19 observers, 10 used the actual VOT system, and the remaining 9 used the simulated VOT system; there were also 10 patients with tuberculosis. The patients, actual VOT observers, and simulated VOT observers exhibited about 70%, 65%, and 50% compliance, respectively, in terms of following the standard operating procedures every day. The scores of all groups on all dimensions were well above the average scores. There was no significant difference in any of the dimensional scores among the three groups. Conclusions The updated version of the TH VOT system was deemed usable by both the patients and the health care staff. Compliance with the use of the system was high among the patients but moderate among the observers.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Video-Observed Therapy With a Notification System for Improving the Monitoring of Tuberculosis Treatment in Thailand: Usability Study

Kumwichar¹,

Chongsuvivatwong²,

Prappre³

2022

JMIR Form Res

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“…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...…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Four observational studies in high income countries of Australia and United States of America between 2012 and 2021 evaluated the cost effectiveness of this model, Three of these have shown an incremental cost-savings ranging between $1391 and $2,226 when comparing VOT with using in-person DOT and VOT was therefore the preferred cost-effective option (35) (36) (43). Another retrospective cohort design in Australia comparing patients receiving direct observation by home videophone with patients receiving this service in person have shown the incremental costeffectiveness ratio (ICER) to be AUD$1.32 (95% CI: $0.51 -$2.26) per extra day of successful observation with VOT.…”

Section: Video Observed Treatment (Vot)mentioning

confidence: 99%

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

Sejie¹,

Mahomed

2022

Preprint

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Background Tuberculosis (TB) is a major public health problem throughout the world particularly in resource limited countries. In light of the global urgency to improve TB care, the World Health Organisation emphasize the importance of taking into consideration the journey of a TB patient through a series of interlinked settings and facilities. One of these is decentralising TB care beyond health facilities and harness the contribution of communities through provision of effective community-based directly observed therapy (DOT) to TB patients at greatest socio-economic risk. A systematic review was conducted to map previously conducted studies to identify existing community TB implementation models, their effectiveness on cost and treatment outcomes. Methods Systematic search through various electronic databases electronic databases; Medline/PubMed, EBSCO (PsycINFO and CINAHL) and Cochrane libraries was performed between the year 2000 and 2021. We used the following free text search terms Tuberculosis, Community tuberculosis, cost effectiveness and treatment outcomes for this purpose. Their quality was scored by ROBINS-I and ROB 2. Results A total of 6982 articles were identified with 36 meeting the eligibility criteria for analysis. Two observational studies in low- and middle-income countries reported comparable video observed t reatment completion rates to in-person directly observed therapy (0.99-1.47(95% CI 0.93-2,25) with one randomised control trial in a high-income country reporting an increased video observed treatment success rate to standard care (OR 2.52, 95% CI 1.17-5.47). An incremental cost saving ranged was $1391-$2226. Electronic medication monitors increased the probability of treatment success rate (RR 1.0-4.33 and the 95% CI 0.98-95.4) in four cohort studies in low- and middle-income countries with incremental cost effectiveness of $434. Four cohort studies evaluating community health worker direct observation therapy in low- and middle-income countries showed treatment success risk ratio ranging between 0.29-3.09 with 95% CI 0.06-7.88. (32,41,43,48) with incremental cost effectiveness up to USS$410 while four randomised control trials in low- and middle-income countries reported family directly observed treatment success odds ratios ranging 1.03- 1.10 95% CI 0.41-1.72. Moreover, four comparative studies in low- and middle-income countries showed family directly observed treatment success risk ratio ranging 0.94- 9.07 ,95% CI 0.92- 89.9. Lastly four Short Message Service trials revealed a treatment success risk ratio ranging 1.0–1.45, 95% CI fell within these values) with cost effectiveness of up to 350I$ compared to standard of care. Conclusions This review illustrates that community-based TB interventions such as video observed therapy, electronic medication monitors, community health worker direct observation therapy, family directly observed treatment and short Message Service can substantially bolster efficiency and convenience for patients and providers thus saving costs and improving clinical outcomes.

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“…Although this adoption of telehealth is still nascent and actively evolving based on the needs of patients and health system resources, there is a history of telehealth use for video-based direct observed therapy (vDOT) for patients with active TB disease [15,16]. VDOT is a convenient and cost-effective alternative to daily in-person observation that is especially valuable during the COVID-19 pandemic [17]. Whether this benefit extends to appointments for children undergoing daily TBI therapy that is not directly observed has not been well studied.…”

Section: Introductionmentioning

confidence: 99%

Telehealth Reduces Missed Appointments in Pediatric Patients with Tuberculosis Infection

et al. 2022

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Pediatric patients with untreated tuberculosis infection (TBI), also called latent TBI, are at risk of progression to active TB disease. The primary aim of this study was to identify factors associated with higher rates of missed appointments and failure to complete therapy for pediatric patients with TBI. A secondary aim was to determine the impact of the COVID-19 pandemic and the rise of telehealth on TBI missed appointment rates. We first performed a retrospective chart review of 129 pediatric patients referred to the free Yale Pediatric Winchester Chest Tuberculosis Clinic from 2016–2019. Associations between demographic/clinical variables and missed appointments/failure to complete therapy were analyzed using univariate and bivariate chi-square tests. Language, lack of primary provider, and distance to clinic were the main contributors to missed appointments and poor treatment adherence. There was an association between the number of missed appointments and failure to complete treatment (p = 0.050). A second cohort of 29 patients was analyzed from January–December 2021 when telehealth was offered for follow-up appointments. Of these follow-up visits, 54% were conducted via telehealth, and the clinic’s missed appointment rate dropped significantly from 16.9% to 5.8% during this time frame (p = 0.037). These data demonstrate that telehealth is accepted as an alternative by patients for follow-up TBI visits.

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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

Cited by 24 publications

References 23 publications

Video-Observed Therapy With a Notification System for Improving the Monitoring of Tuberculosis Treatment in Thailand: Usability Study

Video-Observed Therapy With a Notification System for Improving the Monitoring of Tuberculosis Treatment in Thailand: Usability Study

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

Telehealth Reduces Missed Appointments in Pediatric Patients with Tuberculosis Infection

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