Garrett R. Beeler Asay, Chee Kin Lam, Brock Stewart, Joan M. Mangan, Suzanne M. Marks, Sapna Bamrah Morris, Andrew N. Hill, and Anila Thomas are with the Division of Tuberculosis Elimination; National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; Atlanta, GA. Laura Romo, Chris E. Keh, and Teresita J. Ampie are with the San Francisco Department of Public Health, Population Health Division, Disease Prevention and Control Branch, Tuberculosis Prevention and Control, San Francisco, CA. Caroline L. Gummo and Kristen St John are with the Rhode Island Department of Health, Center for HIV, Hepatitis, STD, and Tuberculosis Epidemiology, Providence. Michelle Macaraig, Christine Chuck, and Joseph Burzynski are with the Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY.
Am J Public Health. 2020 Nov;110(11):1696-1703. doi: 10.2105/AJPH.2020.305877. Epub 2020 Sep 17.
To assess costs of video and traditional in-person directly observed therapy (DOT) for tuberculosis (TB) treatment to health departments and patients in New York City, Rhode Island, and San Francisco, California. We collected health department costs for video DOT (VDOT; live and recorded), and in-person DOT (field- and clinic-based). Time-motion surveys estimated provider time and cost. A separate survey collected patient costs. We used a regression model to estimate cost by DOT type. Between August 2017 and June 2018, 343 DOT sessions were captured from 225 patients; 87 completed a survey. Patient costs were lowest for VDOT live ($1.01) and highest for clinic DOT ($34.53). The societal (health department + patient) costs of VDOT live and recorded ($6.65 and $12.64, respectively) were less than field and clinic DOT ($21.40 and $46.11, respectively). VDOT recorded health department cost was not statistically different from field DOT cost in Rhode Island. Among the 4 different modalities, both types of VDOT were associated with lower societal costs when compared with traditional forms of DOT. VDOT was associated with lower costs from the societal perspective and may reduce public health costs when TB incidence is high.
评估视频和传统面对面直接观察治疗（DOT）在纽约市、罗德岛和加利福尼亚州旧金山为卫生部门和患者带来的结核病（TB）治疗成本。我们收集了视频 DOT（VDOT；直播和录像）和面对面 DOT（现场和诊所）的卫生部门成本。时间动作调查估计了提供者的时间和成本。一项单独的调查收集了患者的成本。我们使用回归模型按 DOT 类型估算成本。2017 年 8 月至 2018 年 6 月，从 225 名患者中捕获了 343 次 DOT 疗程；87 名完成了调查。VDOT 直播的患者成本最低（1.01 美元），诊所 DOT 最高（34.53 美元）。VDOT 直播和录像的社会（卫生部门+患者）成本（分别为 6.65 美元和 12.64 美元）低于现场和诊所 DOT（分别为 21.40 美元和 46.11 美元）。在罗德岛，VDOT 录像的卫生部门成本与现场 DOT 成本在统计学上没有差异。在这 4 种不同的模式中，与传统形式的 DOT 相比，两种类型的 VDOT 都与较低的社会成本相关。从社会角度来看，VDOT 与较低的成本相关，当结核病发病率较高时，可能会降低公共卫生成本。
