模拟数字依从性技术对埃塞俄比亚结核病差异化治疗的流行病学和经济影响。

Modelling the epidemiological and economic impact of digital adherence technologies with differentiated care for tuberculosis treatment in Ethiopia.

作者信息

Goscé Lara, Tadesse Amare Worku, Foster Nicola, van Kalmthout Kristian, Rest Job van, van der Wal Jense, Harker Martin J, Madden Norma, Abdurhman Tofik, Gadissa Demekech, Bedru Ahmed, Dube Tanyaradzwa N, Alacapa Jason, Mganga Andrew, Deyanova Natasha, Charalambous Salome, Letta Taye, Jerene Degu, White Richard, Fielding Katherine L, Houben Rein Mgj, McQuaid Christopher Finn

机构信息

TB modelling Group, TB centre, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Public Health, London, UK

Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK.

出版信息

BMJ Glob Health. 2024 Dec 9;9(12):e016997. doi: 10.1136/bmjgh-2024-016997.

DOI:10.1136/bmjgh-2024-016997

PMID:39653521

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11628985/

Abstract

BACKGROUND

Digital adherence technologies (DATs) with associated differentiated care are potential tools to improve tuberculosis (TB) treatment outcomes and reduce associated costs for both patients and healthcare providers. However, the balance between epidemiological and economic benefits remains unclear. Here, we used data from the ASCENT trial to estimate the potential long-term epidemiological and economic impact of DAT interventions in Ethiopia.

METHODS

We developed a compartmental transmission model for TB, calibrated to Ethiopia and parameterised with patient and provider costs. We compared the epidemiological and economic impact of two DAT interventions, a digital pillbox and medication labels, to the current standard of care, assuming each was introduced at scale in 2023. We projected long-term TB incidence, mortality and costs to 2035 and conducted a threshold analysis to identify the maximum possible epidemiological impact of a DAT intervention by assuming 100% treatment completion for patients on DAT.

FINDINGS

We estimated small and uncertain epidemiological benefits of the pillbox intervention compared with the standard of care in Ethiopia, with a difference of -0.4% (95% uncertainty interval (UI) -1.1%; +2.0%) incident TB episodes and -0.7% (95% UI -2.2%; +3.6%) TB deaths. However, our analysis also found large total provider and patient cost savings (US$163 (95% UI US$118; US$211) and US$3 (95%UI: US$1; US$5), respectively, over 2023-2035), translating to a 50.2% (95% UI 35.9%; 65.2%) reduction in total cost of treatment. Results were similar for the medication label intervention. The maximum possible epidemiological impact a theoretical DAT intervention could achieve over the same timescale would be a 3% (95% UI 1.4%; 5.5%) reduction in incident TB and an 8.2% (95% UI 4.4%; 12.8%) reduction in TB deaths.

INTERPRETATION

DAT interventions, while showing limited epidemiological impact, could substantially reduce TB treatment costs for both patients and the healthcare provider.

摘要

背景

具备相关差异化护理的数字依从技术（DATs）是改善结核病（TB）治疗效果并降低患者和医疗服务提供者相关成本的潜在工具。然而，流行病学效益和经济效益之间的平衡仍不明确。在此，我们利用ASCENT试验的数据来估计DAT干预措施在埃塞俄比亚可能产生的长期流行病学和经济影响。

方法

我们开发了一个用于结核病的 compartmental 传播模型，根据埃塞俄比亚的情况进行校准，并采用患者和医疗服务提供者的成本进行参数化。我们将两种DAT干预措施（数字药盒和药物标签）与当前的护理标准进行了流行病学和经济影响的比较，假设每种干预措施在2023年大规模引入。我们预测了到2035年的长期结核病发病率、死亡率和成本，并进行了阈值分析，通过假设接受DAT治疗的患者100%完成治疗来确定DAT干预措施可能产生的最大流行病学影响。

结果

与埃塞俄比亚的护理标准相比，我们估计药盒干预措施的流行病学效益较小且不确定，结核病发病例数的差异为-0.4%（95%不确定区间（UI）-1.1%；+2.0%），结核病死亡的差异为-0.7%（95% UI -2.2%；+3.6%）。然而，我们的分析还发现，医疗服务提供者和患者的总成本大幅节省（在2023年至2035年期间分别为163美元（95% UI 118美元；211美元）和3美元（95% UI：1美元；5美元）），相当于治疗总成本降低了50.2%（95% UI 35.9%；65.2%）。药物标签干预措施的结果类似。在同一时间范围内，理论上的DAT干预措施可能实现的最大流行病学影响将是结核病发病例数减少3%（95% UI 1.4%；5.5%），结核病死亡减少8.2%（95% UI 4.4%；12.8%）。