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The Interactive Care Coordination and Navigation mHealth Intervention for People Experiencing Homelessness: Cost Analysis, Exploratory Financial Cost-Benefit Analysis, and Budget Impact Analysis.

作者信息

McCullough Hannah P, Moczygemba Leticia R, Avanceña Anton L V, Baffoe James O

机构信息

Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, 2409 University Avenue, Austin, TX, 78712, United States, 1 512-232-6880.

Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, United States.

出版信息

JMIR Form Res. 2025 Mar 18;9:e64973. doi: 10.2196/64973.


DOI:10.2196/64973
PMID:40101159
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11936304/
Abstract

BACKGROUND: The Interactive Care Coordination and Navigation (iCAN) mobile health intervention aims to improve care coordination and reduce hospital and emergency department visits among people experiencing homelessness. OBJECTIVE: This study aimed to conduct a three-part economic evaluation of iCAN, including a (1) cost analysis, (2) exploratory financial cost-benefit analysis, and (3) budget impact analysis (BIA). METHODS: We collected cost and expenditure data from a randomized controlled trial of iCAN to conduct a cost analysis and exploratory financial cost-benefit analysis. Costs were classified as startup and recurring costs for participants and the program. Startup costs included participant supplies for each participant and SMS implementation costs. Recurring costs included the cost of recurring services, SMS text messaging platform maintenance, health information access fees, and personnel salaries. Using the per participant per year (PPPY) costs of iCAN, the minimum savings reduction in the average health care costs among people experiencing homelessness that would lead to a benefit-cost ratio >1 for iCAN was calculated. This savings threshold was calculated by dividing the PPPY cost of iCAN by the average health care costs among people experiencing homelessness multiplied by 100%. The benefit-cost ratio of iCAN was calculated under different savings thresholds from 0% (no savings) to 50%. Costs were calculated PPPY under different scenarios, and the results were used as inputs in a BIA. A probabilistic sensitivity analysis was conducted to incorporate uncertainty around cost estimates. Costs are in 2022 US $. RESULTS: The total cost of iCAN was US $2865 PPPY, which was made up of US $265 in startup (9%) and US $2600 (91%) in recurring costs PPPY. The minimum savings threshold that would cause iCAN to have a positive return on investment is 7.8%. This means that if average health care costs (US $36,917) among people experiencing homelessness were reduced by more than 7.8% through iCAN, the financial benefits would outweigh the costs of the intervention. When health care costs are reduced by 25% ($9229/$36,917; equal to 56% [$9229/$16,609] of the average cost of an inpatient visit), the benefit-cost ratio is 3.22, which means that iCAN produces US $2.22 in health care savings per US $1 spent. The BIA estimated that implementing iCAN for 10,250 people experiencing homelessness over 5 years would have a financial cost of US $28.7 million, which could be reduced to US $2.2 million if at least 8% ($2880/$36,917) of average health care costs among people experiencing homelessness are reduced through the intervention. CONCLUSIONS: If average costs of emergency department and hospital visits among people experiencing homelessness were reduced by more than 7.8% ($2880/$36,917) through iCAN, the financial benefits would outweigh the costs of the intervention. As the savings threshold increases, it results in a higher benefit-cost ratio.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e095/11936304/840abbf8c7ce/formative-v9-e64973-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e095/11936304/840abbf8c7ce/formative-v9-e64973-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e095/11936304/840abbf8c7ce/formative-v9-e64973-g001.jpg

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[1]
The Interactive Care Coordination and Navigation mHealth Intervention for People Experiencing Homelessness: Cost Analysis, Exploratory Financial Cost-Benefit Analysis, and Budget Impact Analysis.

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本文引用的文献

[1]
Leveraging mHealth Technologies for Public Health.

JMIR Public Health Surveill. 2024-9-12

[2]
Connecting Female Entertainment Workers in Cambodia to Health Care Services Using mHealth: Economic Evaluation of Mobile Link.

JMIR Form Res. 2024-7-25

[3]
Emergency Department Visits by Homeless Status and Sex: United States, 2016-2021.

Natl Health Stat Report. 2024-6

[4]
Characteristics and Health Care Utilization of Patients With Housing Insecurity in the ED.

JAMA Netw Open. 2024-4-1

[5]
Hospital Readmissions Among Patients Experiencing Homelessness: An Electronic Health Record Data Study.

Perm J. 2024-3-15

[6]
mHealth application for improving treatment outcomes for patients with multidrug-resistant tuberculosis in Vietnam: an economic evaluation protocol for the V-SMART trial.

BMJ Open. 2023-12-11

[7]
Cost-effectiveness of Digital Tools for Behavior Change Interventions Among People With Chronic Diseases: Systematic Review.

Interact J Med Res. 2023-2-16

[8]
The Use of Technology to Provide Mental Health Services to Youth Experiencing Homelessness: Scoping Review.

J Med Internet Res. 2023-1-16

[9]
Budget impact analysis of breast cancer medications: a systematic review.

J Pharm Policy Pract. 2022-12-29

[10]
The cost-effectiveness of digital health interventions: A systematic review of the literature.

Front Public Health. 2022

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