Department of Global Health, University of Washington, Seattle, WA, United States.
Kenyatta National Hospital, Nairobi, Kenya.
JMIR Mhealth Uhealth. 2020 Oct 2;8(10):e18351. doi: 10.2196/18351.
Mobile health (mHealth) approaches offer potentially affordable ways to support the care of HIV-infected patients in overstretched health care systems. However, only few studies have analyzed the costs associated with mHealth solutions for HIV care.
The aim of this study was to estimate the total incremental costs and incremental cost per beneficiary of an interactive SMS text messaging support intervention within a clinical trial.
The Mobile WAChX trial (NCT02400671) evaluates an interactive semiautomated SMS text messaging intervention to improve adherence to antiretroviral therapy and retention in care among peripartum women infected with HIV in Kenya to reduce the mother-to-child transmission of HIV. Women were randomized to receive one-way versus two-way SMS text messages. Messages were sent weekly, and these messages included motivational and educational content and visit reminders; two-way messaging enabled prompt consultation with the nurse as needed. Microcosting methods were used to collect resource-use data related to implementing the Mobile WAChX SMS text messaging intervention. At 2 sites (Nairobi and Western Kenya), we conducted semistructured interviews with health personnel to identify startup and recurrent activities by obtaining information on the personnel, supplies, and equipment. Data on expenditures and prices from project expense reports, administrative records, and published government salary data were included to estimate the total incremental costs. Using a public provider perspective, we estimated incremental unit costs per beneficiary and per contact during 2017.
The weighted average annual incremental costs for the two-way SMS text messaging group were US $3725 per facility, US $62 per beneficiary, and US $0.85 per contact to reach 115 beneficiaries. For the one-way SMS text messaging group, the weighted average annual incremental costs were US $2542 per facility, US $41 per beneficiary, and US $0.66 per contact to reach 117 beneficiaries. The largest cost shares were for the personnel: 48.2% (US $1794/US $3725) in two-way and 32.4% (US $825/US $2542) in one-way SMS text messaging groups. Costs associated with software development and communication accounted for 29.9% (US $1872/US $6267) of the costs in both intervention arms (US $1042 vs US $830, respectively).
Cost information for budgeting and financial planning is relevant for implementing mHealth interventions in national health plans. Given the proportion of costs related to systems development, it is likely that costs per beneficiary will decline with the scale-up of the interventions.
移动医疗（mHealth）方法为支持在医疗保健系统负担过重的情况下对感染艾滋病毒的患者进行护理提供了潜在的经济实惠的途径。然而，只有少数研究分析了与艾滋病毒护理的 mHealth 解决方案相关的成本。
本研究旨在估算一项交互式短信文本消息支持干预措施在临床试验中的总增量成本和每位受益人的增量成本。
Mobile WAChX 试验（NCT02400671）评估了一种交互式半自动短信文本消息干预措施，以提高肯尼亚围产期感染艾滋病毒的妇女对抗逆转录病毒治疗的依从性和保留在护理中的依从性，从而降低艾滋病毒母婴传播的风险。妇女被随机分配接受单向与双向短信文本消息。每周发送消息，这些消息包括动机和教育内容以及访问提醒；双向消息使需要时能够与护士进行快速咨询。使用微观成本法收集与实施 Mobile WAChX 短信文本消息干预措施相关的资源使用数据。在 2 个地点（内罗毕和肯尼亚西部），我们对卫生人员进行了半结构化访谈，通过获取有关人员、用品和设备的信息，确定了启动和经常性活动。项目费用报告、行政记录和已发表的政府工资数据中的支出和价格数据包括在内，以估算总增量成本。从公共提供者的角度来看，我们根据 2017 年的每位受益人和每次接触的成本，估算了每位受益人和每次接触的增量单位成本。
双向短信文本消息组的加权平均年度增量成本为每个设施 3725 美元，每位受益人为 62 美元，每位受益人为 115 人，每次接触 0.85 美元。在单向短信文本消息组中，加权平均年度增量成本为每个设施 2542 美元，每位受益人为 41 美元，每位受益人为 117 人，每次接触 0.66 美元。最大的成本份额是人员：双向短信文本消息组为 48.2%（1794 美元/3725 美元），单向短信文本消息组为 32.4%（825 美元/2542 美元）。软件开发和通信相关成本占两个干预组成本的 29.9%（6267 美元中的 1872 美元）（分别为 1042 美元和 830 美元）。
预算编制和财务规划的成本信息对于在国家卫生计划中实施 mHealth 干预措施很重要。鉴于与系统开发相关的成本比例，每个受益人的成本很可能会随着干预措施的扩大而下降。
