Cost-effectiveness of directly observed tuberculosis treatment through digital health

• Grant number: 25/10017-5
• Support Opportunities: Scholarships abroad - Research
• Start date: November 10, 2025
• End date: August 10, 2026
• Field of knowledge: Health Sciences - Nursing - Public Health Nursing
• Principal Investigator: Jaqueline Garcia de Almeida Ballestero
• Grantee: Jaqueline Garcia de Almeida Ballestero
• Host Investigator: Jonathon Campbell
• Host Institution: Escola de Enfermagem de Ribeirão Preto (EERP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil
• Institution abroad: McGill University, Canada
• Associated research grant: 22/08510-7 - Interaction and effect of the COVID-19 pandemic on Tuberculosis control in the State of São Paulo: political-social, clinical-epidemiological aspects and innovative practices, AP.TEM

Abstract

This proposal is part of the Thematic Project "Interaction and effects of the COVID-19 pandemic on tuberculosis control in the state of São Paulo: political-social, clinical-epidemiological aspects and innovative practices" (FAPESP Grant No. 2022/08510-7), and falls under the research axis focused on the incorporation of digital technologies in health, with an emphasis on monitoring tuberculosis (TB) treatment. The study will be conducted at the McGill International Tuberculosis Centre (MTBC), McGill University, Canada, under the supervision of Prof. Dr. Jonathon R. Campbell, an international reference in health economics and cost-effectiveness analysis in TB control. Introduction: Conventional directly observed therapy (DOT) has long been an important strategy in the care of individuals with tuberculosis, despite presenting operational and financial limitations for its implementation. In this context, the use of digital health strategies to monitor treatment emerges as a feasible alternative to strengthen adherence to prescribed drug therapy-particularly the VDOT modality, i.e., video directly observed therapy. However, it is essential to assess the costs and cost-effectiveness of each treatment modality in order to support decision-making by healthcare managers and professionals. Thus, the objective of this study is to evaluate the costs, cost-effectiveness, and budget impact of offering VDOT for TB treatment monitoring in comparison to conventional DOT and self-administered treatment in municipalities in the state of São Paulo. Method: This is a comparative cost-effectiveness study. It will be conducted in eight municipalities in the state of São Paulo that have implemented VDOT. Data will be collected through interviews with individuals undergoing TB treatment and through records from the São Paulo state health information system. For individuals in treatment, costs will be estimated across five components: (1) treatment costs by monitoring modality; (2) operational costs related to medication acquisition; (3) costs associated with hospitalization; (4) costs related to nutritional supplements and comorbidities; and (5) costs related to health insurance and loans. For the health system, unit cost estimates for each care activity will be multiplied by the number of actions performed. Societal costs will be calculated as the sum of costs borne by individuals with TB and the health system. Cost-effectiveness will be assessed by calculating the incremental cost-effectiveness ratio (ICER), comparing the different treatment monitoring modalities to VDOT. The cost of VDOT monitoring will also be estimated by multiplying the calculated costs (from the perspectives of TB patients, the health system, and society) by the average TB incidence in the state of São Paulo over the past ten years. The study adheres to strict ethical standards and has been approved by the Research Ethics Committee of EERP-USP and registered in ReBEC. Expected Results: In addition to generating relevant scientific evidence to inform public health management decisions, this proposal aims to enhance strategies for combating tuberculosis and to contribute to the production of knowledge aligned with the needs of the Brazilian Unified Health System (SUS). It also seeks to increase the national and international visibility of research carried out at the Ribeirão Preto College of Nursing, University of São Paulo, particularly within the Department of Maternal-Child and Public Health Nursing. The findings are expected to improve the quality of care provided to people with TB, reduce catastrophic costs associated with treatment, promote therapeutic adherence, and advance progress toward the World Health Organization's (WHO) TB elimination targets. (AU)