ArticlePloS one2020
Drones and digital adherence monitoring for community-based tuberculosis control in remote Madagascar: A cost-effectiveness analysis.
Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
16 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Rethinking Tuberculosis Morbidity Quantification: A Systematic Review and Critical Appraisal of TB Disability Weights in Cost-Effectiveness Analyses.PharmacoEconomics · 2024Pooled it
- Cost and cost-effectiveness of digital technologies for support of tuberculosis treatment adherence: a systematic review.BMJ global health · 2024Pooled it
- The cost-effectiveness of digital health interventions: A systematic review of the literature.Frontiers in public health · 2022Pooled it
- Current and potential uses of drones in healthcare delivery in sub-Saharan Africa: a rapid scoping review.Global health action · 2026Article
- New frontiers for unmanned aerial vehicles in planetary health research.BMC global and public health · 2026Review
- Community-based mobile tuberculosis clinics in rural Madagascar: impact and cost-effectiveness analysis.BMJ global health · 2025Article
- Public health surveillance of tropical diseases in Madagascar: a scoping review of population burden, intervention strategies, and health system responses.BMC public health · 2025Article
- Intention to use mobile phone-based TB screening among HIV patients in Debre Tabor Town public health facilities, Northwest Ethiopia: a cross-sectional study.BMC public health · 2025Article
- Modelling the epidemiological and economic impact of digital adherence technologies with differentiated care for tuberculosis treatment in Ethiopia.BMJ global health · 2024Article
- Healthcare providers' and community stakeholders' perception of using drones for tuberculosis diagnosis in Nepal: an exploratory qualitative study.BMC health services research · 2024Article
- Inter-facility transfers for emergency obstetrical and neonatal care in rural Madagascar: a cost-effectiveness analysis.BMJ open · 2024Article
- Ending tuberculosis: challenges and opportunities.Frontiers in tuberculosis · 2024Review
- Using drones to improve care for HIV-exposed children in Conakry, Republic of Guinea: Anthropological perspectives.PLOS global public health · 2024Article
- Improving early infant diagnosis for HIV-exposed infants using unmanned aerial vehicles for blood sample transportation in Conakry, Guinea: a comparative cost-effectiveness analysis.BMJ global health · 2023Article
- Exploring factors affecting the adoption and continuance usage of drone in healthcare: The role of the environment.PLOS digital health · 2023Article
- Technologies for Medication Adherence Monitoring and Technology Assessment Criteria: Narrative Review.JMIR mHealth and uHealth · 2022Review
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundContinuing tuberculosis control with current approaches is unlikely to reach the World Health Organization's objective to eliminate TB by 2035. Innovative interventions such as unmanned aerial vehicles (or drones) and digital adherence monitoring technologies have the potential to enhance patient-centric quality tuberculosis care and help challenged National Tuberculosis Programs leapfrog over the impediments of conventional Directly Observed Therapy (DOTS) implementation. A bundle of innovative interventions referred to for its delivery technology as the Drone Observed Therapy System (DrOTS) was implemented in remote Madagascar. Given the potentially increased cost these interventions represent for health systems, a cost-effectiveness analysis was indicated.
methodsA decision analysis model was created to calculate the incremental cost-effectiveness of the DrOTS strategy compared to DOTS, the standard of care, in a study population of 200,000 inhabitants in rural Madagascar with tuberculosis disease prevalence of 250/100,000. A mixed top-down and bottom-up costing approach was used to identify costs associated with both models, and net costs were calculated accounting for resulting TB treatment costs. Net cost per disability-adjusted life years averted was calculated. Sensitivity analyses were performed for key input variables to identify main drivers of health and cost outcomes, and cost-effectiveness.
findingsNet cost per TB patient identified within DOTS and DrOTS were, respectively, $282 and $1,172. The incremental cost per additional TB patient diagnosed in DrOTS was $2,631 and the incremental cost-effectiveness ratio of DrOTS compared to DOTS was $177 per DALY averted. Analyses suggest that integrating drones with interventions ensuring highly sensitive laboratory testing and high treatment adherence optimizes cost-effectiveness.
conclusionInnovative technology packages including drones, digital adherence monitoring technologies, and molecular diagnostics for TB case finding and retention within the cascade of care can be cost effective. Their integration with other interventions within health systems may further lower costs and support access to universal health coverage.
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