A COST-EFFECTIVENESS ANALYSIS OF DIRECTLY OBSERVED THERAPY VS SELF-ADMINISTERED THERAPY FOR TREATMENT OF TUBERCULOSIS

Study objectives: To compare the costs and effectiveness of directly o bserved therapy (DOT) vs self-administered therapy (SAT) for the treat ment of active tuberculosis. Design: Decision analysis. Setting: We us ed published rates for failure of therapy, relapse, and acquired multi drug resistance during the initial treatment of drug-susceptible tuber culosis cases using DOT or SAT, We estimated costs of tuberculosis tre atment at an urban tuberculosis control program, a municipal hospital, and a hospital specializing in treating drug-resistant tuberculosis, Outcome measures: The average cost per patient to cure drug-susceptibl e tuberculosis, including the cost of treating failures of initial tre atment. Results: The direct costs of initial therapy with DOT and SAT were similar ($1,206 vs $1,221 per patient, respectively), although DO T was more expensive when patient time costs were included, When the c osts of relapse and failure were included in the model, DOT was less e xpensive than SAT, whether considering outpatient costs only ($1,405 v s $2,314 per patient treated), outpatient plus inpatient costs ($2,785 vs $10,529 per patient treated), or outpatient, inpatient, and patien ts' time costs ($3,999 vs $12,167 per patient treated). Threshold anal ysis demonstrated that DOT was less expensive than SAT through a wide range of cost estimates and clinical event rates. Conclusion: Despite its greater initial cost, DOT is a more cost-effective strategy than S AT because it achieves a higher cure rate after initial therapy, and t hereby decreases treatment costs associated viith failure of therapy a nd acquired drug resistance, This cost-effectiveness analysis supports the widespread implementation of DOT.