TY - JOUR T1 - Evaluating the potential costs and impact of digital health technologies for tuberculosis treatment support JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.01363-2018 SP - 1801363 AU - Ntwali Placide Nsengiyumva AU - Benjamin Mappin-Kasirer AU - Olivia Oxlade AU - Mayara Bastos AU - Anete Trajman AU - Dennis Falzon AU - Kevin Schwartzman Y1 - 2018/01/01 UR - http://erj.ersjournals.com/content/early/2018/08/23/13993003.01363-2018.abstract N2 - Ensuring adherence and support during treatment of tuberculosis (TB) is a major public health challenge. Digital health technologies could help improve treatment outcomes. We considered their potential cost and impact on treatment for active or latent TB in Brazil.Decision analysis models simulated two adult cohorts with 1) drug-susceptible active TB, and 2) multidrug-resistant TB; and two cohorts treated with isoniazid for latent TB infection (LTBI): 1) close contacts of persons with active TB, and 2) others newly diagnosed with LTBI. We evaluated four digital support strategies: two different medication monitors (MMs), synchronous video-observed therapy (VOT), and two-way short message service (SMS). Comparators were standard directly observed treatment for active TB and self-administered treatment for LTBI. Projected outcomes included costs (2016 USD), plus active TB cases and disability-adjusted life years (DALYs) averted among persons with LTBI.For individuals with active TB, MMs and VOT are projected to lead to substantial (up to 58%) cost savings, in addition to alleviating inconvenience and cost to patients of supervised treatment visits. For LTBI treatment, SMS and MMs are projected to be the most cost-effective interventions. However, all projections are limited by the scarcity of published estimates of clinical effect for the digital technologies.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Nsengiyumva reports grants from European Respiratory Society, during the conduct of the study.Conflict of interest: Mr. Mappin-Kasirer has nothing to disclose.Conflict of interest: Dr. Oxlade has nothing to disclose.Conflict of interest: Dr. Trajman has nothing to disclose.Conflict of interest: Dr. Falzon reports a grant to employer from European Respiratory Society, during the conduct of the study.Conflict of interest: Dr. Schwartzman reports grants from European Respiratory Society through the Global TB Programme of the World Health Organization, during the conduct of the study; .Conflict of interest: Dr. Lisboa Bastos has nothing to disclose. ER -