Costs of digital adherence technologies for tuberculosis treatment support

Digital adherence technologies (DATs) are increasingly used for tuberculosis (TB) adherence support, but information about their costs remains limited. We used microcosting to estimate health system costs (in 2022 US dollars) of 99DOTS pill sleeves and video-observed treatment (VOT), implemented in demonstration projects during 2018-21. Local cost estimates for standard directly observed treatment (DOT) were also obtained. The estimated per-person costs of 99DOTS for drug-sensitive (DS-) TB were $98, $106, and $174 in Bangladesh (n=719), the Philippines (n=396), and Tanzania (n=976) respectively. The estimated per-person costs of VOT were $1 154, $304, $457, and $661 in Haiti (n=87 DS-TB), Moldova (n=173 DS-TB), Moldova (n=135 drug-resistant [DR]-TB) and the Philippines (n=110 DR-TB) respectively. Health system costs of 99DOTS may be similar to or cheaper than standard DOT. VOT is considerably more expensive; labor cost offsets and/or economies of scale may yield savings relative to standard DOT in some settings. Summary In diverse settings, health system costs of 99DOTS pill sleeves may be similar to or cheaper than standard directly observed treatment for TB; video-observed treatment is considerably more expensive, but labor cost offsets and/or economies of scale may yield savings. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was supported by a grant from TB REACH, Wave 6 through funding from the Bill and Melinda Gates Foundation (grant number OPP1139029) and Global Affairs Canada (grant number CA-3-D000920001). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: N/A I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors