Telemonitoring for patients with inflammatory bowel disease amid the COVID-19 pandemic-A cost-effectiveness analysis.

BACKGROUND AND AIM: COVID-19 pandemic burdens the healthcare systems, causes healthcare avoidance, and might worsen the outcomes of inflammatory bowel disease (IBD) management. We aimed to estimate the impact of pandemic-related avoidance on outpatient IBD management, and the cost-effectiveness of adding telemonitoring during pandemic from the perspective of Hong Kong public healthcare provider. METHODS: The study was performed by a decision-analytic model to estimate the quality-adjusted life-years (QALYs) and cost of care for IBD patients before and during the pandemic, and to compare the cost and QALYs of adding telemonitoring to standard care (SC-TM) versus standard care alone (SC) for IBD patients during the pandemic. The sources of model inputs included publications (retrieved from literature search) and public data. Sensitivity analyses were conducted to examine the robustness of base-case results. RESULTS: Standard care with pandemic-related avoidance (versus without avoidance) lost 0.0026 QALYs at higher cost (by USD43). The 10,000 Monte Carlo simulations found standard care with pandemic-related avoidance lost QALYs and incurred higher cost in 100% and 96.82% of the time, respectively. Compared with the SC group, the SC-TM group saved 0.0248 QALYs and reduced cost by USD799. Monte Carlo simulations showed the SC-TM group gained higher QALYs at lower cost in 100% of 10,000 simulations. CONCLUSIONS: Standard care for IBD patients during pandemic with healthcare avoidance appears to worsen treatment outcomes at higher cost and lowered QALYs. The addition of telemonitoring to standard care seems to gain higher QALYs and reduce cost, and is therefore a potential cost-effective strategy for IBD management during the pandemic.

Cost-effectiveness of video-observed therapy for ambulatory management of active tuberculosis during the COVID-19 pandemic in a high-income country.

OBJECTIVE: The coronavirus 2019 (COVID-19) pandemic caused suspension of directly observed therapy (DOT) for patients with active tuberculosis (TB). This study aimed to estimate the outcomes of pandemic-related DOT suspension and the cost-effectiveness of video-observed therapy (VOT) during the pandemic. METHODS: A decision-analytic model was constructed to project outcomes of adult patients with active TB from the perspective of a US healthcare provider. Two model-based analyses were conducted: (1) before (with DOT) and during [with self-administered therapy (SAT)] the pandemic; and (2) VOT vs SAT during the pandemic. The primary outcome measures were direct medical costs and disability-adjusted life years (DALYs). RESULTS: In the base-case analysis, care during the pandemic (with SAT) increased the cost (by US$285 per patient) and DALYs (by 0.2155 per patient) in comparison with DOT. Care with VOT reduced DALYs (by 0.4870) and costs (by US$1797) in comparison with SAT. On probabilistic sensitivity analysis, care during the pandemic (with SAT) increased DALYs in 100% of 10,000 simulations, and increased costs in 55.52% of instances. Care with VOT reduced DALYs and costs in 99.7% and 68.79% of instances, respectively. The probability of VOT being cost-effective was 99.4% at the willingness-to-pay threshold of 50,000 US$/DALY. CONCLUSION: Suspension of DOT during the COVID-19 pandemic worsened treatment outcomes. VOT was found to be a cost-effective option for active TB care in an outpatient setting.

Impact of COVID-19 infection control measures on influenza-related outcomes in Hong Kong.

Following the announcement of coronavirus disease 2019 (COVID-19) cases in Wuhan on 31 December 2019, government officials in Hong Kong recommended the wearing of face masks as a public infection control measure against the COVID-19 virus and curtail the impact of the concurrent influenza season. The present study evaluated the influenza-related outcomes between the influenza season 2019 and 2020 in Hong Kong as a result of these infection control measures. A Monte Carlo simulation model was designed to estimate the number of influenza cases, clinic visits, hospitalization, deaths, direct medical cost and disability-adjusted life-years (DALYs) for the season 2018-2019 and 2019-2020 in six age groups: 0-5 years, 6-11 years, 12-17 years, 18-49 years, 50-64 years and ≥65 years in Hong Kong. Model inputs were derived from public data and existing literature. The model findings showed significant reduction in influenza-related cases, clinic visits, hospitalization, and deaths in 2020 versus 2019 (p < 0.05). Influenza-related direct costs in all age-groups were significantly reduced by 56%-82% (p < 0.01) in 2020 versus 2019. DALYs were also significantly decreased by 58%-85% (p < 0.01). The direct cost and DALYs avoided in 2020 was the highest among the age group of 0-5 years with a cost-saving of USD593,763 (95%CI 590,730-596,796) per 10,000 population and a DALY reduction of 57.67 (95%CI 57.54-57.83) per 10,000 population. This study illustrated the reduction of all influenza-related outcome measures in Hong Kong as a result of the implementation of public infection control measures against COVID-19.