Obesity Research and Care Group, Division of Population Health Sciences, School of Physiotherapy, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland.
Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland.
JMIR Mhealth Uhealth. 2021 Sep 14;9(9):e31621. doi: 10.2196/31621.
Mobile health (mHealth) may improve pediatric weight management capacity and the geographical reach of services, and overcome barriers to attending physical appointments using ubiquitous devices such as smartphones and tablets. This field remains an emerging research area with some evidence of its effectiveness; however, there is a scarcity of literature describing economic evaluations of mHealth interventions.
We aimed to assess the economic viability of using an mHealth approach as an alternative to standard multidisciplinary care by evaluating the direct costs incurred within treatment arms during a noninferiority randomized controlled trial (RCT).
A digitally delivered (via a smartphone app) maintenance phase of a pediatric weight management program was developed iteratively with patients and families using evidence-based approaches. We undertook a microcosting exercise and budget impact analysis to assess the costs of delivery from the perspective of the publicly funded health care system. Resource use was analyzed alongside the RCT, and we estimated the costs associated with the staff time and resources for service delivery per participant.
In total, 109 adolescents participated in the trial, and 84 participants completed the trial (25 withdrew from the trial). We estimated the mean direct cost per adolescent attending usual care at €142 (SD 23.7), whereas the cost per adolescent in the mHealth group was €722 (SD 221.1), with variations depending on the number of weeks of treatment completion. The conversion rate for the reference year 2013 was $1=€0.7525. The costs incurred for those who withdrew from the study ranged from €35 to €681, depending on the point of dropout and study arm. The main driver of the costs in the mHealth arm was the need for health professional monitoring and support for patients on a weekly basis. The budget impact for offering the mHealth intervention to all newly referred patients in a 1-year period was estimated at €59,046 using the assessed approach.
This mHealth approach was substantially more expensive than usual care, although modifications to the intervention may offer opportunities to reduce the mHealth costs. The need for monitoring and support from health care professionals (HCPs) was not eliminated using this delivery model. Further research is needed to explore the cost-effectiveness and economic impact on families and from a wider societal perspective.
ClinicalTrials.gov NCT01804855; https://clinicaltrials.gov/ct2/show/NCT01804855.
移动医疗（mHealth）可以提高儿科体重管理能力和服务的地理覆盖范围，并克服使用智能手机和平板电脑等无处不在的设备参加身体预约的障碍。该领域仍然是一个新兴的研究领域，有一些证据表明其有效性；然而，描述 mHealth 干预措施的经济评估的文献很少。
我们旨在通过评估非劣效性随机对照试验（RCT）中治疗臂内的直接成本，评估使用 mHealth 方法替代标准多学科护理的经济可行性。
使用基于证据的方法，与患者和家属一起迭代开发了一个数字化提供的（通过智能手机应用程序）儿科体重管理计划的维持阶段。我们进行了微观成本核算和预算影响分析，从公共资助的医疗保健系统的角度评估了交付成本。资源使用情况与 RCT 一起进行了分析，我们估计了与每个参与者的服务交付相关的员工时间和资源成本。
共有 109 名青少年参加了试验，84 名参与者完成了试验（25 名退出试验）。我们估计，接受常规护理的青少年的平均直接成本为 142 欧元（SD 23.7），而 mHealth 组的青少年成本为 722 欧元（SD 221.1），具体取决于治疗完成的周数。2013 年的换算率为 1 美元=0.7525 欧元。那些退出研究的人的费用从 35 欧元到 681 欧元不等，具体取决于退出点和研究臂。mHealth 臂的主要成本驱动因素是需要每周对患者进行健康专业人员的监测和支持。使用评估方法，在 1 年内为所有新转诊患者提供 mHealth 干预措施的预算影响估计为 59,046 欧元。
这种 mHealth 方法的成本明显高于常规护理，尽管对干预措施进行修改可能会提供降低 mHealth 成本的机会。使用这种交付模式并没有消除医疗保健专业人员（HCP）的监测和支持需求。需要进一步研究从更广泛的社会角度探索成本效益和对家庭的经济影响。
ClinicalTrials.gov NCT01804855; https://clinicaltrials.gov/ct2/show/NCT01804855.
