Table 3. Provider and societal costs for digital adherence technologies (DATs) without video observation, and the standard of care (SoC) grouped by type of intervention in 2022 international dollars.
| Study | Country | DAT pts. | Cointervention | Duration | SOC | Costs per person treated | Costs included | ||
| DAT | SoC | Incremental | |||||||
| Digital pillbox studies | Provider costs per person treated | ||||||||
| Bahrainwala et al40 (2020) | Madagascar | 475* | – | 6 months | SAT | $4797 | $4765 | $32 | S, D, T, F, I, O |
| 276* | DOT (clinic)+SAT | 6 months | DOT (clinic)+SAT | $1914 | $1862 | $51 | |||
| Broomhead and Mars38 (2012) | S. Africa | 24* | DOT (NR) | 6 months | DOT alone (NR) | $1787 | $2273 | –$486 | S, D, F, I |
| Mukora et al49 (2022) | S. Africa | 1305† | – | 6 months | SAT | $118 | $67 | $51 | Abstract only |
| Nsengiyumva et al19 (2018) | Brazil | NR* | – | 6 months - DS | DOT (clinic) | $826 | $1815 | –$990 | S, D, T, F, I, O |
| 18 months - DR | DOT (clinic) | $20 992 | $24 566 | –$3574 | |||||
| 9 mo - TBIG | SAT | $174 | $98 | $76 | |||||
| 9 mo - TBIC | SAT | $187 | $117 | $70 | |||||
| Saha et al33 (2022) | India | 200 | – | 6 months | DOT (NR) | $370 | $269 | $101 | S, T, F, I |
| Yang et al39 (2022) | Morocco | 206 | – | 6 months | SAT | $1053 | $411 | $642 | S, D, T, F, I, O |
| NR‡ | – | 6 months | DOT+SAT§ | $1968 | $1635 | $333 | |||
| Societal costs per person treated | |||||||||
| Manyazewal et al25 (2022) | Ethiopia | 52 | – | 2 months | DOT (clinic) | $1.85 | $33 | –$31 | P |
| Nsengiyumva et al19 (2018) | Brazil | NR* | – | 6 months - DS | DOT (clinic) | $1120 | $2438 | –$1318 | S, D, T, F, I, O, P |
| 18 months - DR | DOT (clinic) | $21 911 | $26 645 | –$4734 | |||||
| 9 months - TBIG | SAT | $422 | $326 | $96 | |||||
| 9 months - TBIC | SAT | $441 | $353 | $88 | |||||
| SMS studies | Provider costs per person treated | ||||||||
| Gashu et al42 (2021) | Ethiopia | 131† | DOT (family) | 4 months | N/A | $0.50 | T (airtime only) | ||
| Louwagie et al27 (2022) | S. Africa | 122 | Motivational interviewing | 3 months | SAT | $554 | $119 | $435 | S, D, F, I, O |
| Nsengiyumva et al19 (2018) | Brazil | NR* | Patient reply | 9 months - TBIG | SAT | $115 | $98 | $18 | S, D, T, F, I, O |
| 9 months - TBIC | SAT | $127 | $117 | $10 | |||||
| Peng et al26 2014) | China | 234 | – | 6 months | DOT (NR) | $71 | $212 | –$141 | Abstract only |
| Societal costs per person treated | |||||||||
| Nsengiyumva et al19 2018) | Brazil | NR* | Patient reply | 9 months - TBIG | SAT | $371 | $326 | $45 | S, D, T, F, I, O, P |
| 9 months - TBIC | SAT | $386 | $353 | $33 | |||||
| 99DOTS studies | Provider costs per person treated | ||||||||
| Nsengiyumva et al19 (2018) | Brazil | NR* | – | 6 months - DS | DOT (clinic) | $769 | $1815 | –$1046 | S, D, T, F, I, O |
| 18 months - DR | DOT (clinic) | $20 916 | $24 566 | –$3650 | |||||
| 9 months - TBIG | SAT | $117 | $98 | $20 | |||||
| 9 months - TBIC | SAT | $131 | $117 | $14 | |||||
| Nsengiyumva et al20 (2023) | Tanzania | 976 | – | 6 months | DOT (family) | $469 ($439) | $0.00 | $469 ($439) | S, T, F, I |
| Bangladesh | 719 | – | 6 months | DOT (clinic) | $280 ($231) | $211 | $69 ($20) | ||
| Philippines | 396 | – | 6 months | DOT (clinic) | $308 ($229) | $511 | –$203 (–$281) | ||
| Thompson et al29 (2022) | Uganda | 1800/year* | – | 6 months | DOT (family) | $963 ($163) | $0 | $963 ($163) | S, T, F, I, O |
| Waswa et al28 (2022) | Uganda | 1086 | – | 6 months - Calc. | None | $76 | Abstract only¶ | ||
| Societal costs per person treated | |||||||||
| Nsengiyumva et al19 (2018) | Brazil | NR* | – | 6 months - DS | DOT (clinic) | $672 | $1539 | –$868 | S, D, T, F, I, O, P |
| 18 months - DR | DOT (clinic) | $13 787 | $16 824 | –$3037 | |||||
| 9 months - TBIG | SAT | $230 | $206 | $25 | |||||
| 9 months - TBIC | SAT | $243 | $223 | $20 | |||||
| Other studies | Intervention | Provider costs per person treated | |||||||
| Au-Yeung and DiCarlo30 (2012) | USA | NR* | Ingestible sensors | 4 months | DOT (clinic)** | $1618 | $2289 | –$671 | S, D, T, F |
| Daftary et al31 (2017) | Ethiopia | 2300 (approx.) | Interactive voice calls | 6 months - IPT | N/A | $148 | – | – | T |
| Societal costs per person treated | |||||||||
| Au–Yeung and DiCarlo30 (2012) | USA | NR* | Ingestible sensors | 4 months | DOT (clinic)** | $1680 | $3030 | –$1350 | S, D, T, F, P |
Costs included S, staff; D, drugs and treatment; T, travel and supplies; F, fixed assets and technology; I, implementation; O, overhead; P, patient expenses).
TBI C Cohort modelled based on persons who were close contacts of persons with contagious TB disease. G Cohort modelled as unselected persons with TBI.
Cost in parentheses are calculated with fixed costs annuitised over a 5-year useful life.
These patients were a modelled cohort. For Broomhead and Mars,38 while the 24 patients did receive the intervention in a pilot programme, the costs were entirely modelled using literature values. For Bahrainwala et al,40 the costs are presented per diagnosed patient only (to ensure comparability between other studies). Thompson et al29 used observed costs (from 891 intervention patients) and applied them to a modelled clinic with a service volume of 1800 patients per year.
Target number of patients from protocol of parent randomised controlled trial.
This study observed costs from an implementation of 206 patients but then modelled costs in a separate scenario considering costs of retreatment, MDR development and treatment, etc.
2 months of DOT (facility details not reported) followed by 4 months of SAT. The model considers most patients as drug-sensitive (6-month treatment course); however, patients on retreatment are modelled to be treated for 8 months and MDR patients for 24 months.
Costs described as ‘running costs only’ (ie, excluding start-up costs).
3X/week DOT is shown for Au-Yeung and DiCarlo.30
DRdrug-resistantDSdrug susceptibleIPTIsoniazid preventative therapy for TBI in people living with HIVNRnot reportedSATself-administered therapySMSshort message serviceTBtuberculosisTBITB infection