Cost-Effectiveness of a Medication Event Monitoring System for Tuberculosis Management in Morocco

Background Poor adherence to tuberculosis (TB) treatment can result in community transmission and drug resistance. Digital health technologies have been used to enhance adherence to TB medication for proper management, but the cost-effectiveness of this approach remains unclear.Methods We used the real data from the study conducted from April 2014 to December 2020 in Morocco to enhance the adherence to drug-susceptible TB treatment using a smart pillbox with a web-based medication monitoring system, called Medication Event Monitoring Systems (MEMS). We applied a Markov model adding Multi-drug resistant (MDR) TB to evaluate the costs and cost-effectiveness of MEMS, compared to the standard of care (modified directly observed treatment and intervention) from the health perspective. The primary outcome was the incremental cost-effectiveness ratio (ICER) per disability adjusted life-year (DALY) averted. We also performed two-way sensitive analysis between treatment success rate of MEMS and standard of care. Results The average total per-patient health system costs for treating a new TB patient under MEMS versus standard of care were $398.7 and $155.7, respectively. The MEMS strategy would reduce the number of drug-susceptible TB cases by 0.17 and MDR-TB cases by 0.01 per patient over five years. The ICER of MEMS was $434/DALY averted relative to standard of care, and was most susceptible to the TB treatment success rate of both strategies followed by the managing cost of MEMS.Conclusion MEMS is considered cost-effective for managing infectious active TB in Morocco.