A cost-effectiveness analysis of directly observed therapy vs self-administered therapy for treatment of tuberculosis.
OBJECTIVE
To compare the costs and effectiveness of directly observed therapy (DOT) vs self-administered therapy (SAT) for the treatment of active tuberculosis.


METHODS
Decision analysis.


METHODS
We used published rates for failure of therapy, relapse, and acquired multidrug resistance during the initial treatment of drug-susceptible tuberculosis cases using DOT or SAT. We estimated costs of tuberculosis treatment at an urban tuberculosis control program, a municipal hospital, and a hospital specializing in treating drug-resistant tuberculosis.


METHODS
The average cost per patient to cure drug-susceptible tuberculosis, including the cost of treating failures of initial treatment.


RESULTS
The direct costs of initial therapy with DOT and SAT were similar ($1,206 vs $1,221 per patient, respectively), although DOT was more expensive when patient time costs were included. When the costs of relapse and failure were included in the model, DOT was less expensive than SAT, whether considering outpatient costs only ($1,405 vs $2,314 per patient treated), outpatient plus inpatient costs ($2,785 vs $10,529 per patient treated), or outpatient, inpatient, and patients' time costs ($3,999 vs $12,167 per patient treated). Threshold analysis demonstrated that DOT was less expensive than SAT through a wide range of cost estimates and clinical event rates.


CONCLUSIONS
Despite its greater initial cost, DOT is a more cost-effective strategy than SAT because it achieves a higher cure rate after initial therapy, and thereby decreases treatment costs associated with failure of therapy and acquired drug resistance. This cost-effectiveness analysis supports the widespread implementation of DOT.
Burman
W J
WJ
Denver Disease Control Service, Denver Health and Hospitals, and the Department of Medicine, University of Colorado Health Sciences Center, 80204, USA.
Dalton
C B
CB
Cohn
D L
DL
Butler
J R
JR
Reves
R R
RR
D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D003140:Communicable Disease Control / Q000191:economics; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D004359:Drug Therapy, Combination; D017721:Hospital Costs; D006801:Humans; D010349:Patient Compliance; D012646:Self Administration; D017211:Treatment Failure; D014376:Tuberculosis / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
D000995:Antitubercular Agents