Background High prevalence of smoking tobacco among people with tuberculosis (TB) contribute towards poor outcomes in low- and middle-income countries. A mobile phone-based intervention for smoking cessation among this population (mTB-Tobacco) was evaluated for its cost-effectiveness alongside a cluster randomised controlled trial in Pakistan and Bangladesh. Methods A two-arm superiority cluster randomised controlled trial with 6 months follow up was conducted between September 2023 and January 2025 in Dhaka, Bangladesh and Punjab, Pakistan. The trial compared the mTB-Tobacco intervention with usual care as control. Participants included those older than or equal to 15 years of age, diagnosed with drug-sensitive pulmonary TB in the past 4 weeks, smoked tobacco daily but willing to quit, and had access to mobile phones. Eighteen TB health facilities (cluster) were randomised to mTB-Tobacco group (n=720 participants) and nine to usual care (n=360 participants). The primary analysis was an incremental cost-utility analysis from a public/voluntary sector perspective and primary outcome measure was Quality-Adjusted Life Years (QALYs). Total costs included the costs of TB treatment, costs of intervention or control, and costs of doctor visit and hospital stay. . Secondary and sensitivity analyses were also conducted. Findings Total costs were INT$ (international dollars) 36·17 (95% CI 3·65 to 65·81) higher and QALYs were 0·017 (95% CI 0·003 to 0·030) higher in mTB-Tobacco group than usual care group. Increment cost-effectiveness ratio was calculated at INT$2,127·64 per QALY gained. Estimates by country suggested mTB-Tobacco being unlikely cost-effective in Bangladesh (ICER = INT$4,261·11 per QALY gained) but likely cost-effective in Pakistan (ICER = INT$1,024·29 per QALY gained). Interpretation If decision makers in the public/voluntary sector are willing to pay over INT$2,100 for one additional QALY gained, mTB-Tobacco intervention could likely be cost-effective. Funding The UK NIHR Global Health Research Unit on Respiratory Health (RESPIRE) (NIHR132826).
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)