Digital Medication Device Improves Quality of Life, Reduces Costs for TB Patients

Digital health technology has been a trending topic of investigation across a multitude of healthcare specialties. Many studies aim to find out if these tools can improve treatment adherence in patients to ultimately achieve better disease outcomes and management.

An analysis published today found that patients with pulmonary tuberculosis (TB) were able to improve their quality of life while reducing the monumental costs that come with the disease by utilizing a digital medication event reminder monitor (MERM).

The Secondary Analysis of Patients with TB

The team of investigators, including Tsegahun Manyazewal, PhD, Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, focused on adults with new or previously treated, bacteriologically confirmed, drug-sensitive pulmonary TB. Participating patients had to be eligible to start first-line, anti-TB therapy.

The study was a secondary analysis of a randomized, 2-arm, open-label trial. The pre-specified secondary endpoints—health-related quality of life (HRQoL), direct and indirect costs on an individual patient perspective, plus common factors associated with lower HRQoL and higher catastrophic costs—were adopted from the original trial.

The enrollment period was from June 2020-June 2021 and a total of 109 eligible patients from 10 healthcare facilities in Ethiopia were included in the final analysis. Following randomization, patients were given a 15-day TB medication supply to self-administer and refill throughout the 2-month observational treatment phase. The control group (n=57) received standard directly observed therapy, while the intervention group (n=52) received a medication event reminder monitor that dispensed the medication and complementary therapy.

Health-related quality of life was measured using the EuroQoL 5-dimension 5-level (EQ-5D-5L) tool and the World Health Organization’s Tool to Estimate Patient Costs was implemented to assess direct (out-of-pocket) and indirect (guardian and coping) catastrophic costs.

Digital Medication Event Reminder Monitor Improves Outcomes

The secondary analysis demonstrated a significant HRQoL improvement in the intervention group compared with the control group, with no patients showing indications of severe or extreme problems in any of the EQ-5D-5L sections.

Patients with the highest HRQoL scores exhibited no problems in the EQ-5D-5L dimensions of mobility (78.9%), self-care (80.7%), usual activities (61.5%), pain or discomfort (60.6%), and anxiety or depression (63.3%). Conversely, among those with the most issues, pain or discomfort (39.4%) represented the most common problem in the EQ-5D-5L dimensions while self-care (19.3%) was the least represented.

The comparison also revealed that the lower catastrophic cost rates among the intervention group were significant. The tuberculosis treatment costs among patients in the control group ranged from the US dollar equivalent of $0-$310.34, or Ethiopian birr (ETB) 0-16,200, whereas the cost range of the intervention group was $0-$8.81, or ETB 0-460.

Trial group placement was the single deciding factor associated with low HRQoL. Important factors in catastrophic cost included trial group placement, occupation, number of cohabitants, and smoking.

Patients in both groups faced catastrophic costs, however, the difference was substantial with 31 patients in the control group compared with 11 patients in the intervention group. Demographic data from the patient population showed the average age was 33.1 years, 66.1% were men, and 13.9% had a co-infection of HIV.

Investigators inferred that patient-centered digital health technologies have the potential to overcome impediments related to antiTB therapy.

“These results suggest that digital health technologies may improve quality of life and reduce catastrophic costs among patients with pulmonary tuberculosis, in particular those who face structural barriers to standard therapy,” investigators concluded.

The study, “Effect of Digital Medication Event Reminder and Monitor-Observed Therapy vs Standard Directly Observed Therapy on Health-Related Quality of Life and Catastrophic Costs in Patients With Tuberculosis A Secondary Analysis of a Randomized Clinical Trial” was published in JAMA Infectious Diseases.