Cost effectiveness of mHealth intervention by community health workers for reducing maternal and newborn mortality in rural Uttar Pradesh, India

Abstract

BackgroundA variety of mobile-based health technologies (mHealth) have been developed for use by community health workers to augment their performance. One such mHealth intervention—ReMiND program, was implemented in a poor performing district of India. Despite some research on the extent of its effectiveness, there is significant dearth of evidence on cost-effectiveness of such mHealth interventions. In this paper we evaluated the incremental cost per disability adjusted life year (DALY) averted as a result of ReMiND intervention as compared to routine maternal and child health programs without ReMiND.MethodsA decision tree was parameterized on MS-Excel spreadsheet to estimate the change in DALYs and cost as a result of implementing ReMiND intervention compared with routine care, from both health system and societal perspective. A time horizon of 10 years starting from base year of 2011 was considered appropriate to cover all costs and effects comprehensively. All costs, including those during start-up and implementation phase, besides other costs on the health system or households were estimated. Consequences were measured as part of an impact assessment study which used a quasi-experimental design. Proximal outputs in terms of changes in service coverage were modelled to estimate maternal and infant illnesses and deaths averted, and DALYs averted in Uttar Pradesh state of India. Probabilistic sensitivity analysis was undertaken to account for parameter uncertainties.ResultsCumulatively, from year 2011 to 2020, implementation of ReMiND intervention in UP would result in a reduction of 312 maternal and 149,468 neonatal deaths. This implies that ReMiND program led to a reduction of 0.2% maternal and 5.3% neonatal deaths. Overall, ReMiND is a cost saving intervention from societal perspective. From health system perspective, ReMiND incurs an incremental cost of INR 12,993 (USD 205) per DALY averted and INR 371,577 (USD 5865) per death averted.ConclusionsOverall, findings of our study suggest strongly that the mHealth intervention as part of ReMiND program is cost saving from a societal perspective and should be considered for replication elsewhere in other states.Electronic supplementary materialThe online version of this article (10.1186/s12962-018-0110-2) contains supplementary material, which is available to authorized users.

An Interactive Text Messaging Intervention to Improve Adherence to Option B+ Prevention of Mother-to-Child HIV Transmission in Kenya: Cost Analysis

“…Personnel costs accounted for the largest share of the total costs in our project (US $1794/US $3725, 48.2% in two-way and US $825/US $2542, 32.4% in one-way SMS text messaging intervention groups), followed by software development of the SMS text messaging management system and communication costs. Our results are consistent with findings from previous studies that labor costs for delivering other SMS text messaging interventions were the main drivers of the total program costs, followed by SMS text messaging program development [ 11 , 12 , 22 ]. How could we potentially reduce system development and communication-related costs as well as personnel costs?…”

“…The costs during a 2-year period (2011-2012) were estimated to be US $29.33 per user and US $4.33 per successful contact. The ReMiND (Reducing Maternal and Newborn Deaths) Project was designed to improve the quality of counseling of community health workers in India [ 12 ]. The mHealth app was implemented through 259 accredited social health activist workers.…”

“…In a global survey conducted by the World Health Organization, lack of evidence on economic evaluation was identified as a major barrier to implementation of mHealth solutions in resource-constrained settings [ 10 ]. One of the reasons was the limited availability of data on the cost of implementing SMS text messaging interventions [ 11 , 12 ]. Only 1 study has performed a cost analysis of one-way SMS text messaging promoting the availability of HIV self-testing kits in Kenyan clinics [ 13 ].…”

Toward Integration of mHealth in Primary Care in the Netherlands: A Qualitative Analysis of Stakeholder Perspectives

“…A health insurer's main interest is to create best value for money and keep premiums low. mHealth has the potential to provide health services at decreased costs (33,34). Particularly with regard to disease prevention, health insurers will actively promote the supply of effective mHealth solutions.…”

“…They mainly think from their own perspective. The scale-up of mHealth can only be achieved when stakeholders step BOX 2 | Guidelines for nancing eHealth solutions (33).…”