JMIR Publications

ABSTRACT

Background:

Mobile Link is a mobile phone-based intervention to increase access to, and use of, healthcare services among female entertainment workers (FEWs) in Cambodia who face higher risks for specific diseases and gender-based violence. A multisite randomized controlled trial showed that Mobile Link connected FEWs with outreach workers for information and escorted referrals after six months but did not lead to statistically significant improvements in HIV and STI testing, contraceptive use, and condom use.

Objective:

The objective of this study is to conduct a three-part economic evaluation of Mobile Link to understand its costs, value, and affordability.

Methods:

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 to usual care. Using a probabilistic decision-analytic model, we estimated the one-year cost-effectiveness of Mobile Link from payer and combined payer and patient perspectives by converting trial outcomes 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 FEWs in five years.

Results:

The incremental costs of Mobile Link were $199 from a payer perspective and $195 per person from a combined payer and patient perspective. With an average of 0.018 (95% CI -0.014, 0.05) DALYs averted, Mobile Link’s cost-effectiveness was $11,244 per DALY from a payer perspective ($11,039 per DALY averted from a payer and patient perspective). The costs of Mobile Link would have to decrease by 88%, or its effectiveness would have to be 10 times higher, for the intervention to meet the upper limit of recommended cost-effectiveness thresholds in Cambodia ($1,643 per DALY averted). The five-year cost of scaling Mobile Link to 34,790 FEWs was estimated at $1.64 million or $46 per person per year.

Conclusions:

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 FEWs is estimated to cost less than the costs of the trial. Future research should evaluate the long-term cost and outcomes of Mobile Link. Clinical Trial: NCT03117842