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
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
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
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.
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.