数字技术在支持结核病治疗依从性方面的成本和成本效益：系统评价。

Cost and cost-effectiveness of digital technologies for support of tuberculosis treatment adherence: a systematic review.

机构信息

McGill International Tuberculosis Centre, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.

TB Centre, London School of Hygiene and Tropical Medicine, London, UK.

出版信息

BMJ Glob Health. 2024 Oct 30;9(10):e015654. doi: 10.1136/bmjgh-2024-015654.

DOI:10.1136/bmjgh-2024-015654

Abstract

BACKGROUND

Digital adherence technologies (DATs) may provide a patient-centred approach to supporting tuberculosis (TB) medication adherence and improving treatment outcomes. We synthesised evidence addressing costs and cost-effectiveness of DATs to support TB treatment.

METHODS

A systematic review (PROSPERO-CRD42022313531) identified relevant literature from January 2000 to April 2023 in MEDLINE, Embase, CENTRAL, CINAHL, Web of Science along with preprints from medRxiv, Europe PMC and ClinicalTrials.gov. Studies with observational, experimental or quasi-experimental designs (minimum 20 participants) and modelling studies reporting quantitative data on the cost or cost-effectiveness of DATs for TB infection or disease treatment were included. Study characteristics, cost and cost-effectiveness outcomes were extracted.

RESULTS

Of 3619 titles identified by our systematic search, 29 studies met inclusion criteria, of which 9 addressed cost-effectiveness. DATs included short message service (SMS) reminders, phone-based technologies, digital pillboxes, ingestible sensors and video-observed therapy (VOT). VOT was the most extensively studied (16 studies) and was generally cost saving when compared with healthcare provider directly observed therapy (DOT), particularly when costs to patients were included-though findings were largely from high-income countries. Cost-effectiveness findings were highly variable, ranging from no clinical effect in one study (SMS), to greater effectiveness with concurrent cost savings (VOT) in others. Only eight studies adequately reported at least 80% of the elements required by Consolidated Health Economic Evaluation Reporting Standards, a standard reporting checklist for health economic evaluations.

CONCLUSION

DATs may be cost saving or cost-effective compared with healthcare provider DOT, particularly in high-income settings. However, more data of higher quality are needed, notably in lower-income and middle-income countries which have the greatest TB burden.

摘要

背景

数字依从技术（DATs）可能为支持结核病（TB）药物依从性和改善治疗结果提供以患者为中心的方法。我们综合了关于 DATs 成本和成本效益的证据，以支持 TB 治疗。

方法

一项系统评价（PROSPERO-CRD42022313531）从 2000 年 1 月至 2023 年 4 月在 MEDLINE、Embase、CENTRAL、CINAHL、Web of Science 以及 medRxiv、Europe PMC 和 ClinicalTrials.gov 上检索了相关文献。纳入了具有观察性、实验性或准实验性设计（至少 20 名参与者）和报告关于 DATs 治疗 TB 感染或疾病的成本或成本效益的定量数据的建模研究。提取了研究特征、成本和成本效益结果。

结果

通过我们的系统搜索确定了 3619 个标题，其中 29 项研究符合纳入标准，其中 9 项研究涉及成本效益。DATs 包括短信提醒、基于电话的技术、数字药盒、可摄入传感器和视频观察治疗（VOT）。VOT 研究最多（16 项），与医疗保健提供者直接观察治疗（DOT）相比通常具有成本节约效益，特别是当包括患者成本时——尽管这些发现主要来自高收入国家。成本效益结果差异很大，从一项研究（短信）没有临床效果到其他研究中具有更大效果和伴随成本节约（VOT）不等。只有八项研究充分报告了健康经济评估报告标准（Consolidated Health Economic Evaluation Reporting Standards）至少 80%的要求，该标准是健康经济评估报告的标准清单。