Avanceña Anton L V, Brody Carinne, Chhoun Pheak, Tuot Sovannary, Yi Siyan
Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, United States.
Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, United States.
JMIR Form Res. 2024 Jul 25;8:e52734. doi: 10.2196/52734.
Mobile 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.
This study aims to conduct a 3-part economic evaluation of Mobile Link to understand its costs, value, and affordability.
We 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.
The 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.
This 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.
ClinicalTrials.gov NCT03117842; https://clinicaltrials.gov/study/NCT03117842.
“移动链接”是一项基于手机的干预措施，旨在增加柬埔寨女性娱乐工作者获得和使用医疗保健服务的机会，这些女性面临特定疾病和基于性别的暴力的较高风险。一项多地点随机对照试验表明，“移动链接”在6个月后将女性娱乐工作者与外展工作者联系起来以获取信息并护送转诊，但在艾滋病毒和性传播感染检测、避孕药具使用和避孕套使用方面并未带来统计学上的显著改善。
本研究旨在对“移动链接”进行三部分的经济评估，以了解其成本、价值和可承受性。
我们使用“移动链接”试验及其他来源的成本和结果数据，对“移动链接”进行了成本、成本效益和预算影响分析。对于成本分析，我们估计了“移动链接”与常规护理相比的总成本、人均成本和增量成本。使用概率决策分析模型，我们从支付方以及支付方和患者联合的角度估计了“移动链接”的1年成本效益，方法是将试验中的选定主要和次要结果转换为避免的残疾调整生命年（DALY）。最后，我们估计了在5年内将“移动链接”的信息传递和外展服务扩大到70%的女性娱乐工作者的财务成本。
从支付方角度看，“移动链接”的增量成本为199美元，从支付方和患者联合角度看人均成本为195美元。平均避免了0.018（95%预测区间为-0.088至0.126）个DALY，从支付方角度看，“移动链接”的成本效益为每DALY 10,955美元（从支付方和患者角度看，每避免一个DALY为10,755美元）。为使该干预措施达到柬埔寨推荐的成本效益阈值上限（每避免一个DALY 1671美元），“移动链接”的成本必须降低85%，或者其效果必须提高5.56倍。将“移动链接”扩大到34,790名女性娱乐工作者的5年成本估计为164万美元，即每人每年46美元。
本研究对“移动链接”进行了全面的经济评估。我们发现，“移动链接”不太可能具有成本效益，除非其成本降低或效果提高。将“移动链接”扩大到更多女性娱乐工作者的估计成本低于试验成本。鉴于将女性娱乐工作者与基本服务联系起来的重要性，未来研究应侧重于提高“移动链接”的效果或为该人群开发新的移动健康干预措施。
ClinicalTrials.gov NCT03117842；https://clinicaltrials.gov/study/NCT03117842
