Connecting Female Entertainment Workers in Cambodia to Health Care Services Using mHealth: Economic Evaluation of Mobile Link

BackgroundMobile Link is a mobile phone–based intervention to increase access to, and use of, health care services among female entertainment workers in Cambodia who face higher risks for specific diseases and gender-based violence. A multisite randomized controlled trial showed that Mobile Link connected female entertainment workers with outreach workers for information and escorted referrals after 6 months but did not lead to statistically significant improvements in HIV and sexually transmitted infection testing, contraceptive use, and condom use. ObjectiveThis study aims to conduct a 3-part economic evaluation of Mobile Link to understand its costs, value, and affordability. MethodsWe conducted cost, cost-effectiveness, and budget impact analyses of Mobile Link using cost and outcomes data from the Mobile Link trial and other sources. For the cost analysis, we estimated the total, per-person, and incremental costs of Mobile Link compared with usual care. Using probabilistic decision-analytic models, we estimated the 1-year cost-effectiveness of Mobile Link from payer and combined payer and patient perspectives by converting selected primary and secondary outcomes from the trial to disability-adjusted life years (DALYs) averted. Finally, we estimated the financial costs of scaling up Mobile Link’s messaging and outreach services to 70% of female entertainment workers in 5 years. ResultsThe incremental costs of Mobile Link were US $199 from a payer perspective and US$195 per person from a combined payer and patient perspective. With an average of 0.018 (95% predicted interval –0.088 to 0.126) DALYs averted, Mobile Link’s cost-effectiveness was US $10,955 per DALY from a payer perspective (US$10,755 per DALY averted from a payer and patient perspective). The costs of Mobile Link would have to decrease by 85%, or its effectiveness would have to be 5.56 times higher, for the intervention to meet the upper limit of recommended cost-effectiveness thresholds in Cambodia (US $1671 per DALY averted). The 5-year cost of scaling Mobile Link to 34,790 female entertainment workers was estimated at US$1.64 million or US $46 per person per year. ConclusionsThis study provided a comprehensive economic evaluation of Mobile Link. We found that Mobile Link is not likely to be cost-effective unless its costs decrease or its effectiveness increases. Scaling up Mobile Link to more female entertainment workers is estimated to cost less than the costs of the trial. Given the importance of linking female entertainment workers to essential services, future research should focus on enhancing the effectiveness of Mobile Link or developing new mobile health interventions for this population. Trial RegistrationClinicalTrials.gov NCT03117842; https://clinicaltrials.gov/study/NCT0311784

Cost‐effectiveness of implantable ventricular assist devices in older children with stable, inotrope‐dependent dilated cardiomyopathy

BackgroundIn a stable, inotrope- dependent pediatric patient with dilated cardiomyopathy, we evaluated the cost- effectiveness of continuous- flow VAD implantation compared to a watchful waiting approach using chronic inotropic therapy.MethodsWe used a state- transition model to estimate the costs and outcomes of 14- year- old (INTERMACS profile 3) patients receiving either VAD or watchful waiting. We measured benefits in terms of lifetime QALYs gained. Model inputs were taken from the literature. We calculated the ICER, or the cost per additional QALY gained, of VADs and performed multiple sensitivity analyses to test how our assumptions influenced the results.ResultsCompared to watchful waiting, VADs produce 0.97 more QALYs for an additional $156 639, leading to an ICER of$162 123 per QALY gained from a healthcare perspective. VADs have 17% chance of being cost- effective given a cost- effectiveness threshold of $100 000 per QALY gained. Sensitivity analyses suggest that VADs can be cost- effective if the costs of implantation decrease or if hospitalization costs or mortality among watchful waiting patients is higher.ConclusionsAs a bridge to transplant, VADs provide a health benefit to children who develop stable, inotrope- dependent heart failure, but immediate implantation is not yet a cost- effective strategy compared to watchful waiting based on commonly used cost- effectiveness thresholds. Early VAD support can be cost- effective in sicker patients and if device implantation is cheaper. In complex conditions such as pediatric heart failure, cost- effectiveness should be just one of many factors that inform clinical decision- making.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167783/1/petr13975_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167783/2/petr13975.pd

Cost- effectiveness of implantable ventricular assist devices in older children with stable, inotrope- dependent dilated cardiomyopathy

BackgroundIn a stable, inotrope- dependent pediatric patient with dilated cardiomyopathy, we evaluated the cost- effectiveness of continuous- flow VAD implantation compared to a watchful waiting approach using chronic inotropic therapy.MethodsWe used a state- transition model to estimate the costs and outcomes of 14- year- old (INTERMACS profile 3) patients receiving either VAD or watchful waiting. We measured benefits in terms of lifetime QALYs gained. Model inputs were taken from the literature. We calculated the ICER, or the cost per additional QALY gained, of VADs and performed multiple sensitivity analyses to test how our assumptions influenced the results.ResultsCompared to watchful waiting, VADs produce 0.97 more QALYs for an additional $156 639, leading to an ICER of$162 123 per QALY gained from a healthcare perspective. VADs have 17% chance of being cost- effective given a cost- effectiveness threshold of $100 000 per QALY gained. Sensitivity analyses suggest that VADs can be cost- effective if the costs of implantation decrease or if hospitalization costs or mortality among watchful waiting patients is higher.ConclusionsAs a bridge to transplant, VADs provide a health benefit to children who develop stable, inotrope- dependent heart failure, but immediate implantation is not yet a cost- effective strategy compared to watchful waiting based on commonly used cost- effectiveness thresholds. Early VAD support can be cost- effective in sicker patients and if device implantation is cheaper. In complex conditions such as pediatric heart failure, cost- effectiveness should be just one of many factors that inform clinical decision- making.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167783/1/petr13975_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167783/2/petr13975.pd

An investment case to prevent the reintroduction of malaria in Sri Lanka

AbstractSri Lanka has made remarkable gains in reducing the burden of malaria, recording no locally transmitted malaria cases since November 2012 and zero deaths since 2007. The country was recently certified as malaria free by World Health Organization in September 2016. Sri Lanka, however, continues to face a risk of resurgence due to persistent receptivity and vulnerability to malaria transmission. Maintaining the gains will require continued financing to the malaria program to maintain the activities aimed at preventing reintroduction. This article presents an investment case for malaria in Sri Lanka by estimating the costs and benefits of sustaining investments to prevent the reintroduction of the disease. An ingredient-based approach was used to estimate the cost of the existing program. The cost of potential resurgence was estimated using a hypothetical scenario in which resurgence assumed to occur, if all prevention of reintroduction activities were halted. These estimates were used to compute a benefit-cost ratio and a return on investment. The total economic cost of the malaria program in 2014 was estimated at U.S. dollars (USD) 0.57 per capita per year with a financial cost of USD0.37 per capita. The cost of potential malaria resurgence was, however, much higher estimated at 13 times the cost of maintaining existing activities or 21 times based on financial costs alone. This evidence suggests a substantial return on investment providing a compelling argument for advocacy for continued prioritization of funding for the prevention of reintroduction of malaria in Sri Lanka

Additional file 1 of Achieving malaria testing and treatment targets for children under five in Mozambique: a cost-effectiveness analysis

Additional file 1. Supplemental material