Madagascar has a significant tuberculosis (TB) burden with >29,000 cases identified in 2016. “Drone Observed Therapy System” (DrOTS) was launched in remote Madagascar in 2017 with the goal of improving case finding,
adherence and outcomes for drug susceptible active pulmonary TB with a package of 3 innovative technologies.
- EvriMed : Electronic adherence pill reminders We compared the cost-effectiveness of standard of care Directly Observed Therapy Shortcourse...
A decision tree with arms as DOTS vs DrOTS was built to calculate the Incremental Cost Effectiveness Ratio (ICER) of DrOTS compared to current standard of care DOTS. Mixed top-down and bottom-up approaches were used to identify the costs associated with both,
using empirical literature,
and observed data from the field. Disability Adjusted Life Years (DALYs) associated with the health outcomes were calculated for each arm. Using a threshold value of three times the GDP per...
DrOTS was nearly double the cost of DOTS ($307.00 vs $183.32 per patient). Its greater impact resulted in it being more cost-effective
( ICER of DrOTS vs DOTS was $1015.27/DALY averted). Net Costs ΔCost DALYs ΔDALYs (averted) ICER DOTS $10.79 n/a 0.09 n/a n/a DrOTS $57.23 $46.43 0.05 0.04 $1015.27 For DrOTS to be cost-effective at a threshold willingness to pay of $1294.00 (three times the GDP per capita) requires a
- TB prevalence of 780/100,000,
- an active case finding rate of 66%
DrOTS could be cost-effective compared to DOTS for treatment of drug susceptible active pulmonary TB at less than three times the GDP per capita,
as per WHO standards. Based on the data,
the threshold values are minimum values to meet in order to ensure cost-effectiveness of the intervention,
leading to focusing efforts on increasing case finding and adherence rates. Further studies are necessary to validate these results,
generalize them to other settings,
and assess the impact of future...
WHO TB Country profile- Madagascar.
2017; : 2017. Burman WJ,
A Cost-effectiveness Analysis of Directly Observed Therapy vs Self-administered Therapy for Treatment of Tuberculosis. Chest 1997; 112 : 63–70. Haidari LA,
Ferguson M, et al. The economic and operational value of using drones to transport vaccines. Vaccine 2016; 34 : 4062–7. WHO.
Guidelines for cost and cost-effectiveness analysis of tuberculosis control. Guidel cost...
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In partnership with Madagascar’s National Tuberculosis Control Program,
the Institut Pasteur Madagascar and Stony Brook University’s Valbio Research Center,
the DrOTS project was launched in August 2017 in the Ifanadiana District of Madagascar.
With support from the Stop TB Partnership and government of Canada through a TB REACH wave 5 grant,
this project integrates innovative technologies in the fight against the global tuberculosis epidemic. Contact information- email@example.com,...