Costs and Cost-Effectiveness of Adolescent Compliance With Treatment for Latent Tuberculosis Infection: Results From a Randomized Trial

J Adolesc Health. 2007 Jan;40(1):61-8. doi: 10.1016/j.jadohealth.2006.08.012. Epub 2006 Oct 27.

Abstract

Purpose: Assess the costs and cost-effectiveness of an incentive-based tuberculosis (TB) program designed to promote adolescents' compliance with treatment for latent TB infection (LTBI).

Methods: Randomized controlled trial. Adolescents between the ages of 11 and 19 years who were referred to one of two participating clinics after being screened for TB and receiving a positive diagnosis indicating LTBI (n = 794) were assigned to one of four groups: usual care, peer counseling, contingency contracting, and combined peer counseling/contingency contracting. Primary outcome variables were completion of isoniazid preventive therapy (IPT), total treatment costs, and lifetime TB-related costs per quality-adjusted life year (QALY) in each of the four study groups (three treatment, one control). Cost effectiveness was evaluated using a five-stage Markov model and a Monte Carlo simulation with 10,000 trials.

Results: Average costs were 199 dollars for usual care (UC), 277 dollars for peer counseling (PC), 326 dollars for contingency contracting (CC), and 341 dollars for PC + CC combined. The differences among these groups were all significant at the p = .001 level. Only the PC + CC group improved the rate of IPT completion (83.8%) relative to usual care (75.9%) (p = .051), with an overall incremental CE ratio of 209 dollars per QALY relative to usual care.

Conclusion: Incentives combined with peer counseling are a cost-effective strategy for helping adolescents to complete care when combined with peer counseling.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Antitubercular Agents / therapeutic use
  • Child
  • Contracts
  • Cost-Benefit Analysis
  • Counseling / economics
  • Counseling / methods*
  • Female
  • Health Care Costs*
  • Humans
  • Isoniazid / therapeutic use
  • Logistic Models
  • Los Angeles
  • Male
  • Markov Chains
  • Monte Carlo Method
  • Motivation
  • Patient Compliance* / psychology
  • Peer Group
  • Quality-Adjusted Life Years
  • Reward*
  • Tuberculosis / economics
  • Tuberculosis / prevention & control*

Substances

  • Antitubercular Agents
  • Isoniazid