American Public Health Association, Atlanta, GA, October
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)
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.
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.
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.