A Cost Analysis of Implementing Asynchronous Video Directly Observed Therapy for Monitoring Treatment in Patients with Tuberculosis Disease in Uganda.

Background: Video directly observed treatment (VDOT) supports person-centered care and addresses shortcomings of in-person directly observed treatment (DOTS). However, there is limited literature on implementation costs to inform TB program policy in low-resource settings, such as Uganda. Objective: This study aimed to assess the costs associated with implementing the VDOT intervention in Uganda, based on a completed randomized trial. Methods: We carried out a micro-costing analysis. This employed both bottom-up and top-down approaches to estimate health system costs (in 2024 US dollars) of the VDOT intervention. The analysis covered 71 persons with TB from six health facilities in Kampala, Uganda. Results: The estimated overall costs for implementing VDOT in Uganda were $16,037.80 among 71 patients with TB. The estimated per-person costs for VDOT were $220.93. The largest proportion of the overall cost was associated with smartphones and accessories (29.5%), followed by VDOT platform infrastructure costs (21.7%), program support costs (19.5%), and internet data costs used by patients to send the videos (10.2%). The per-person costs of using VDOT are lower than the potential cost of daily transport that would be associated with facility-based DOT. Conclusion: The implementation of VDOT in Kampala was associated with a relatively low cost compared to the projected cost when using the traditional DOT method. This highlights the cost saving benefit to the patients when using remote treatment monitoring with the video technology. A full economic evaluation from the programmatic and societal perspective is recommended to inform the adoption of the VDOT strategy in resource-limited settings.