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An examination of the cost-effectiveness of peer workers in the treatment of latent TB infection
2001 International Conference of the American Thoracic Society, San Francisco, CA. May 2001.

Glied S, El-Sadr W, Hirsch-Moverman Y, Colson P, Thomas G. An examination of the cost-effectiveness of peer workers in the treatment of latent TB infection. (CDC poster session).

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

Methods: In a randomized clinical trial, a sample of 91 LTBI patients was randomly assigned to peer monitored or current clinical practice groups. The peer monitored group used peer workers, 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 peer worker intervention was assessed from budgets and imputed peer worker 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 peer monitored patients compared to 63% of current clinical practice patients. Peer monitored patients remained in the program longer (7.1 vs. 5.4 months). Fewer patients in the peer monitored group were hospitalized (19.6% vs. 25.7%). Patients in the peer monitored group used more of other health care resources (clinic visits, doctor visits, and ER visits). Using standard cost estimates, the peer monitored group had utilization costs of $4,764 per person, compared with $3,002 for those in the current clinical practice program.

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