Costs and Cost-Effectiveness of Adolescent Compliance with Treatment for Latent Tuberculosis Infection: Results from a Randomized Trial
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 for usual care (UC), $277 for peer counseling (PC), $326 for contingency contracting (CC), and $341 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 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.