Cost-effectiveness analysis of gamified-reality-video-observed-therapy (GRVOTS) for tuberculosis treatment adherence in Selangor and Negeri Sembilan

The World Health Organization Global Tuberculosis Report 2023 indicates that Malaysia’s tuberculosis (TB) incidence rose from approximately 97 per 100,000 population in 2021 to 113 per 100,000 in 2022, reflecting ongoing TB control challenges. Suboptimal TB treatment adherence continues to pose challenges to programme performance and long-term disease control. This study evaluated the cost- effectiveness of the Gamified-Reality-Video-Observed-Therapy (GRVOTS) mobile application, developed by the Universiti Teknologi MARA (UiTM) inventor team led by Dr Nurhuda Ismail, compared with Directly Observed Therapy (DOT) in improving TB treatment adherence in selected government healthcare facilities in Selangor and Negeri Sembilan. A multi-phase study design was employed, comprising secondary data analysis (Phase 1), cost-domain validation using a Modified Nominal Group Technique (Phase 2), and economic evaluation from the provider perspective (Phase 3). DOT data were extracted from the National Tuberculosis Registry (NTBR) for the year 2022, while GRVOTS patient data were obtained from an existing single-arm intervention dataset. TB treatment adherence rate was the primary effectiveness outcome and categorised as “adhere” and “not adhere.” The GRVOTS group recorded 64 adherent patients (90.1%) and 7 non-adherent patients (9.9%), whereas the DOT group recorded 59 adherent patients (83.1%) and 12 non-adherent patients (16.9%) (p = 0.313). The annual provider cost of DOT across five facilities ranged from RM10,832.01 to RM40,421.74, with an overall mean of RM22,099.82 and a mean cost per patient of RM762.06. The total provider cost for GRVOTS ranged from RM63,594.70 to RM83,549.85, with an overall mean of RM72,723.72 and a mean cost per patient of RM36,361.86, reflecting the small number of GRVOTS patients managed per facility (n = 1–4). At the aggregate level, the incremental cost was RM50,623.90 with an incremental effectiveness of five additional adherent patients, resulting in an overall incremental cost-effectiveness ratio (ICER) of RM10,124.78 per additional TB treatment adherence achieved. Facility-level ICERs ranged from RM934.28 to RM11,110.03 per additional adherence, indicating variation according to clinic scale and patient volume. Overall, GRVOTS demonstrated improved TB treatment adherence compared with DOT, with economic performance influenced by implementation scale, supporting further consideration of GRVOTS as a digital adherence strategy within Malaysia’s TB control programme.