Child/Adolescent Health

Incentives combined with peer counseling are a cost-effective way to get adolescents to adhere to a tuberculosis control program

Although the total number of tuberculosis (TB) cases in the United States is decreasing, the proportion of TB cases among foreign-born individuals, including adolescents, is growing. Activation of latent tuberculosis infection (LTBI) is more likely to occur during adolescence due to hormonal changes and altered protein and calcium metabolism associated with adolescent growth. To prevent activation of LTBIs, adolescents must complete a full 6-month course of daily isoniazid preventive therapy (IPT). However, adolescents often have to be persuaded to complete treatment, since LTBIs are generally asymptomatic.

Researchers found that offering adolescents incentives such as gifts, money, or outings with friends, combined with peer education counseling increased their completion of TB treatment programs in a cost-effective way, at a cost of $209 per quality-adjusted life year (QALY). The team randomly assigned 794 adolescents with LTBI to 1 of 4 groups: usual care, peer counseling (PC), contingency contracting (CC, use of incentives), and combined PC/CC.

Average costs were $199 for usual care, $277 for peer counseling (PC), $326 for CC, and $341 for PC and CC combined. Only the PC/CC group improved the rate of IPT completion (83.8 percent) relative to usual care (75.9 percent), with an overall cost-effectiveness ratio of $209 per QALY relative to usual care. The study was supported in part by the Agency for Healthcare Research and Quality (HS00046).

See "Costs and cost-effectiveness of adolescent compliance with treatment for latent tuberculosis infection: Results from a randomized trial," by Gerald F. Kominski, Ph.D., Sepideh Farivar Varon, Ph.D., Donald E. Morisky, Sc.D., and others, in the Journal of Adolescent Health 40, pp. 61-68, 2007.

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