American Public Health Association, Atlanta, GA, October 2001

Glied S, El-Sadr W, Hirsch-Moverman Y, Colson P, Thomas G. Cost-effectiveness of a peer worker model in the treatment of latent TB infection (LTBI)

Rationale: Treatment for LTBI has become a high priority in TB control. Current clinical practice (CCP) for treatment of LTBI is self administered therapy. A peer worker model offers an alternative modality. This study compares cost-effectiveness of the PM and CCP models.

Methods: In a randomized clinical trial, a sample of 91 LTBI patients was randomly assigned to a PM or CCP group. The PM group used peer workers (PW), members of the same community who had completed TB treatment, to provide support and encourage adherence. Information was collected on patients' utilization patterns and outcome measures. Utilization cost data were derived from published sources. The cost of PM was assessed from budgets and imputed PW costs. The cost-effectiveness of the models in terms of treatment completion was compared using standard methods.

Results: Completion of LTBI treatment was achieved by 86% of PM patients compared to 63% of CCP patients. PM patients remained in the program longer (7.1 vs. 5.4 months). Fewer patients in the PM group were hospitalized (19.6% vs. 25.7%). Patients in the PM group used more of other health care resources (clinic visits, doctor visits, and ER visits). Using standard cost estimates, the PM group had utilization costs of $4,764 per person, compared with $3,002 for those in the CCP program.

Conclusions: Our analysis suggests that the PM model is both more effective and more costly than CCP. Thus, the PM strategy may be a cost-effective model for treatment of LTBI.