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

Fekadu, Ginenus; Jiang, Xinchan; Yao, Jiaqi; You, Joyce H.S.

Objective The coronavirus-2019 (COVID-19) pandemic caused suspension of directly observed therapy (DOT) for active tuberculosis (TB). We aimed to estimate the outcomes of pandemic-related DOT suspension and cost-effectiveness of VOT during the pandemic. Methods A decision-analytic model was constructed to project outcomes of adult patients with active TB from the perspective of US healthcare provider. Two model-based analyses were conducted: (1) before (with DOT) and during (with self-administered therapy (SAT)) the pandemic; (2) VOT versus SAT during the pandemic. Primary outcome measures were direct medical costs and disability-adjusted life years (DALYs). Results In base-case analysis, the care during pandemic (with SAT) increased both cost (by USD285) and DALYs (by 0.2155) per patient. VOT reduced DALY (by 0.4870) and saved cost (by USD1,797). In probabilistic sensitivity analysis, the care during pandemic (with SAT) increased DALYs in 100% of 10,000 simulations and increased cost in 55.52% of the time. The care with VOT reduced DALYs and cost in 99.7% and 68.79% of the time, respectively. The probability of VOT to be cost-effective was 99.4% at the willingness-to-pay threshold of 50,000 USD/DALY. Conclusion DOT suspension during pandemic worsened treatment outcomes. VOT was cost-effective for active TB care in outpatient setting.