Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Sep 16, 2019
Open Peer Review Period: Sep 16, 2019 - Sep 23, 2019
Date Accepted: Dec 16, 2019
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Cost-effectiveness of a mobile phone-based support intervention to increase uptake of post-abortion family planning in Cambodia
ABSTRACT
Background:
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 amongst hard-to-reach populations, by providing interactive, personalised support inexpensively wherever the person is located and whenever needed.
Objective:
The objective of this study was to evaluate the cost-effectiveness of mobile phone-based support added to standard post-abortion family planning care in Cambodia, based on results of the MObile Technology for Improved Family Planning (MOTIF) trial.
Methods:
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.
Results:
The incremental cost of mobile phone-based support was estimated to be an additional $8,160.49 per 1000 clients, leading to an estimated 518 couple-years of protection gained per 1,000 clients and 99 disability adjusted life years averted. The Incremental Cost-Effectiveness Ratio (ICER) was $15.75 per additional Couple Year of Protection (CYP) and $82.57 per Disability Adjusted Life Year (DALY) averted. The model was most sensitive to personnel and mobile service costs. Assuming a range of cost-effectiveness thresholds of $58 to $176 for Cambodia, the probability of the intervention being cost-effective ranged from 11% to 95%.
Conclusions:
This study demonstrates that the cost-effectiveness of the intervention delivered by mobile phone studied in the MOTIF trial lies within the estimated range of cost-effectiveness thresholds for Cambodia. When assessing value in interventions to improve the uptake and adherence to 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 to policy makers. Clinical Trial: This study is a cost-effectiveness analysis of the intervention evaluated in the Mobile Technology for Improved Family Planning (MOTIF) trial: ClinicalTrials.gov NCT01823861.
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