Defining a staged-based process for economic and financial evaluations of mHealth programs

Abstract

Mobile and wireless technology for health (mHealth) has the potential to improve health outcomes by addressing critical health systems constraints that impede coverage, utilization, and effectiveness of health services. To date, few mHealth programs have been implemented at scale and there remains a paucity of evidence on their effectiveness and value for money. This paper aims to improve understanding among mHealth program managers and key stakeholders of how to select methods for economic evaluation (comparative analysis for determining value for money) and financial evaluation (determination of the cost of implementing an intervention, estimation of costs for sustaining or expanding an intervention, and assessment of its affordability). We outline a 6 stage-based process for selecting and integrating economic and financial evaluation methods into the monitoring and evaluation of mHealth solutions including (1) defining the program strategy and linkages with key outcomes, (2) assessment of effectiveness, (3) full economic evaluation or partial evaluation, (4) sub-group analyses, (5) estimating resource requirements for expansion, (6) affordability assessment and identification of models for financial sustainability. While application of these stages optimally occurs linearly, finite resources, limited technical expertise, and the timing of evaluation initiation may impede this. We recommend that analysts prioritize economic and financial evaluation methods based on programmatic linkages with health outcomes; alignment with an mHealth solution’s broader stage of maturity and stage of evaluation; overarching monitoring and evaluation activities; stakeholder evidence needs; time point of initiation; and available resources for evaluations.

Establishing Standards to Evaluate the Impact of Integrating Digital Health into Health Systems

“…In 2017, Lefevre et al published a 6-stage process for selecting and integrating economic and financial evaluation methods into the monitoring and evaluation of digital health strategies, with the goal of helping implementers understand the value of economic evaluations as a means to promote future efforts in this space. 46 Funders of digital health need to require the systematic capture of economic data and the assessment of cost and benefits as part of the business case for scale-up.…”

Forecasting the Value for Money of Mobile Maternal Health Information Messages on Improving Utilization of Maternal and Child Health Services in Gauteng, South Africa: Cost-Effectiveness Analysis

“…Yet, little is known about the value for money of maternal SMS text messaging initiatives. Cost-effectiveness analyses (CEAs) aim to generate evidence on the costs and consequences of 2 or more alternatives [ 11 ]. CEAs may be used in conjunction with affordability analyses for informed decision-making on the appropriate and optimal allocation of finite resources [ 11 ].…”

“…Cost-effectiveness analyses (CEAs) aim to generate evidence on the costs and consequences of 2 or more alternatives [ 11 ]. CEAs may be used in conjunction with affordability analyses for informed decision-making on the appropriate and optimal allocation of finite resources [ 11 ]. In the context of digital health programs, the costs required to establish and support the technological components of the program, including architecture, SMS text messaging delivery, device, and other costs, when coupled with the rapid pace of technology turnover, raise questions about the long-term viability and value of these initiatives compared with alternative resource uses.…”

Applicability of the Five Case Model to African eHealth investment decisions

“…Some, such as the Health Impact Assessment approach [16,17], extend beyond economic aspects to deal with broader societal impact, often referred to as socioeconomic impact [18]. Few approaches are speci c to eHealth, with notable exceptions such as the European eHealth IMPACT study [19], the Digital Health Impact Framework (DHIF) developed by the Asian Development Bank [20] and based on the Five Case Model, and a staged-based approach to integrating economic and nancial evaluations speci cally for mobile health initiatives [21].…”