JMIR Publications

ABSTRACT

Background:

The Interactive Care Coordination and Navigation (iCAN) mHealth intervention aims to improve care coordination and reduce avoidable hospital and emergency department (ED) visits among people experiencing homelessness (PEH).

Objective:

The purpose of this study is to assess the costs of iCAN and to perform an exploratory budget impact analysis of iCAN from a payer perspective.

Methods:

We collected cost and expenditure data from an on-going randomized controlled trial of iCAN. Costs were classified as startup and recurring costs for participants and the program. Startup costs included supplies for each participant (e.g., cellphone, phone case, charger) and short messaging service (SMS) implementation costs. Recurring costs included the cost of recurring services (e.g., bus pass, phone plan), text messaging platform maintenance, health information access fees, and personnel salaries. Costs were calculated per participant per year (PPPY) under different scenarios, and the results were used as inputs in a budget impact analysis. The financial cost-benefit associated with iCAN per hospitalization and ED visit averted by the intervention were estimated. Healthcare costs per visit were taken from the 2020 Medical Expenditure Panel Survey. A probabilistic sensitivity analysis was conducted to incorporate uncertainty around cost estimates. All costs are in 2022 US dollars.

Results:

The total costs of iCAN was $2,865 PPPY, which was made up of $265 in startup (9%) and $2,600 (81%) in recurring costs PPPY. The potential cost-savings from iCAN per hospitalization averted are 8.57 (range: 2.87-17.54) times higher than the costs of the intervention. For each ED visit averted, the ratio of cost-savings to intervention costs is 0.63 (range: 0.41-0.92), which suggests that more than one ED visit needs to be averted before iCAN can be cost-saving.

Conclusions:

The annual costs per participant of the iCAN mHealth intervention are roughly $2,800. Reducing just one hospitalization through iCAN can result in significantly lower health expenditures; however, more than one ED visit would have to be prevented in order to achieve cost-savings. Findings suggest that healthcare payers should examine the benefits of mHealth interventions for groups such as PEH.