Evaluating the Cost-Effectiveness of Tuberculosis Video Directly Observed Therapy Program at Harris County Public Health & Environmental Services
Public health professionals are increasingly adopting telehealth to improve the effectiveness of existing services. For example, local health departments in the United States are pilot-testing an alternative approach to Directly Observed Therapy (DOT) among tuberculosis (TB) patients by using video technology. In standard DOT, an individual is required to take medications under the supervision of a healthcare worker in-person. Such a program is in place to increase medication adherence; however, it is labor-intensive, time-consuming, and costly. Alternatively, in the Video Directly Observed Therapy (VDOT), patients record and submit a video clip as evidence of medication adherence through a mobile device, which is then reviewed by the healthcare worker. A few pilot studies have demonstrated the feasibility and effectiveness of VDOT. However, research is limited on the cost-effectiveness of VDOT program. Within the state of Texas, Harris County has the highest number of TB cases and an incidence rate double that of the United States. Harris County Public Health & Environmental Services (HCPHES) is among the first local health departments to implement VDOT at a large-scale. Our study results provide valuable insight into the cost-effectiveness of VDOT at HCPHES. While the adherence rate of standard DOT was higher than that of VDOT (97% vs. 92%, p<0.05), there was less cost associated with VDOT. The use of VDOT instead of DOT saved $61,051.70, which was an 83 percent reduction in total cost. Furthermore, VDOT saved 1,832 driving hours (56,902 driving miles) that would have been spent with standard DOT. While this study demonstrates the value of VDOT, we recommend further research in the cost-effectiveness of VDOT using more refined methods.