Hill Jeremy, McGinn Jourdan, Cairns John, Free Caroline, Smith Chris
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
JMIR Mhealth Uhealth. 2020 Feb 25;8(2):e16276. doi: 10.2196/16276.
Despite progress over the last decade, there is a continuing unmet need for contraception in Cambodia. Interventions delivered by mobile phone could help increase uptake and continuation of contraception, particularly among hard-to-reach populations, by providing interactive personalized support inexpensively wherever the person is located and whenever needed.
The objective of this study was to evaluate the cost-effectiveness of mobile phone-based support added to standard postabortion family planning care in Cambodia, according to the results of the MOTIF (MObile Technology for Improved Family planning) trial.
A model was created to estimate the costs and effects of the intervention versus standard care. We adopted a societal perspective when estimating costs, including direct and indirect costs for users. The incremental cost-effectiveness ratio was calculated for the base case, as well as a deterministic and probabilistic sensitivity analysis, which we compared against a range of likely cost-effectiveness thresholds.
The incremental cost of mobile phone-based support was estimated to be an additional US $8160.49 per 1000 clients, leading to an estimated 518 couple-years of protection (CYPs) gained per 1000 clients and 99 disability-adjusted life-years (DALYs) averted. The incremental cost-effectiveness ratio was US $15.75 per additional CYP and US $82.57 per DALY averted. The model was most sensitive to personnel and mobile service costs. Assuming a range of cost-effectiveness thresholds from US $58 to US $176 for Cambodia, the probability of the intervention being cost-effective ranged from 11% to 95%.
This study demonstrates that the cost-effectiveness of the intervention delivered by mobile phone assessed in the MOTIF trial lies within the estimated range of the cost-effectiveness threshold for Cambodia. When assessing value in interventions to improve the uptake and adherence of family planning services, the use of interactive mobile phone messaging and counselling for women who have had an abortion should be considered as an option by policy makers.
ClinicalTrials.gov NCT01823861; https://clinicaltrials.gov/ct2/show/NCT01823861.
尽管在过去十年中取得了进展，但柬埔寨对避孕措施仍存在持续未满足的需求。通过手机提供的干预措施可以通过在人们所在的任何地点、任何需要的时候以低成本提供交互式个性化支持，帮助提高避孕措施的采用率和持续使用率，特别是在难以接触到的人群中。
根据MOTIF（改善计划生育的移动技术）试验的结果，本研究的目的是评估在柬埔寨标准的流产后计划生育护理中增加基于手机的支持的成本效益。
创建了一个模型来估计干预措施与标准护理的成本和效果。在估计成本时，我们采用了社会视角，包括用户的直接和间接成本。计算了基础案例的增量成本效益比，以及确定性和概率性敏感性分析，并将其与一系列可能的成本效益阈值进行比较。
基于手机的支持的增量成本估计为每1000名客户额外增加8160.49美元，导致每1000名客户估计获得518个夫妇保护年（CYP），避免99个伤残调整生命年（DALY）。增量成本效益比为每增加一个CYP 15.75美元，每避免一个DALY 82.57美元。该模型对人员和移动服务成本最为敏感。假设柬埔寨的成本效益阈值范围为58美元至176美元，干预措施具有成本效益的概率范围为11%至95%。
本研究表明，MOTIF试验中评估的通过手机提供的干预措施的成本效益在柬埔寨成本效益阈值的估计范围内。在评估改善计划生育服务采用率和依从性的干预措施的价值时，政策制定者应考虑将交互式手机信息和咨询用于流产后的妇女作为一种选择。
ClinicalTrials.gov NCT01823861；https://clinicaltrials.gov/ct2/show/NCT01823861 。
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