Cost comparison of wirelessly vs. directly observed therapy for adherence confirmation in anti-tuberculosis treatment

SETTING: A US clinic treating patients entering the continuation phase of treatment for Mycobacterium tuberculosis. OBJECTIVE: To compare the costs of direct confirmation of treatment using wirelessly observed therapy (WOT) vs. standard of care utilizing World Health Organization-recommended 7-day and 3-day directly observed therapy (DOT). DESIGN: A model was created comparing the costs between the two types of DOT and WOT, using data from public sources of treatment, personnel costs, patient spending, and interview responses. The model considered public health facility's cost-to-treat and patient's cost-to-be-treated. Cost drivers for M. tuberculosis treatment monitoring were identified, and four univariate sensitivity analyses were conducted on selected variables. RESULTS: The cost of WOT was estimated to be 36% of 7-day DOT, and 71% of 3-day DOT in public health facility's cost-to-treat. The patient's cost-to-be-treated with WOT was estimated to be 4% of 7-day DOT and 8% of 3-day DOT. Sensitivity analyses indicated that WOT was likely to provide immediate cost savings over a range of WOT costs, time spent on WOT monitoring, WOT-related treatment failure rates and clinician compensations. CONCLUSION: Under several potential cost scenarios, the immediate cost of M. tuberculosis treatment by WOT appears to be substantially less than DOT. Further WOT development for M. tuberculosis treatment appears warranted.