Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Apr 1, 2025
Date Accepted: Aug 8, 2025
Economic Evaluation of a Multi-Component mHealth Intervention for Stroke Management in Rural China: A Cluster-Randomized Trial with Six-Year Follow-Up
ABSTRACT
Background:
To bridge the gap between clinical guidelines and suboptimal stroke management in rural settings, we conducted an implementation trial using evidence-based, mHealth-enabled strategies to empower primary care providers in rural China. The system-integrated and digital technology-enabled model of care (SINEMA) model was shown to significantly reduce blood pressure and mortality among people with stroke in rural China.
Objective:
This study aimed to evaluate the cost-effectiveness of the SINEMA intervention both within the active trial and the post-trial observational periods and its budget impact for potential nationwide scalability.
Methods:
In the cluster-randomized implementation trial - SINEMA trial, 50 villages were randomized to either one-year intervention (2017-8) or usual care with 1,299 stroke patients followed up until 2022-2023—six years after the trial baseline. The incremental cost-effectiveness ratios (ICER) for systolic blood pressure reduction and quality-adjusted life-year (QALY) gains were estimated from health sector perspective. Both probabilistic and deterministic sensitivity analyses were conducted to assess the robustness of the findings. Additionally, a budget impact analysis was performed from a public payer perspective to estimate the per-capita and total costs of national scale-up under two scenarios: a standalone intervention and integration into the existing basic public health service system.
Results:
ICER per 1 mmHg systolic blood pressure reduction was US$8.4 for the within trial estimation; ICER per QALY gained was US$837.9 within-trial and US$727.9 post-trial, both highly cost-effective relative to any commonly adopted thresholds and robust in sensitivity analyses. The first-year budget impact ranged from US$115.6 to US$197.7 million in two scenarios, reducing to US$46.6 to US$78.7 million by year 5 with a per-capita cost of US$0.03-US$0.06.
Conclusions:
Our findings demonstrate that the SINEMA intervention is cost-effective during the trial period and remains so throughout the six-year sustainability observation period. These results highlight the potential of adopting similar health system-integrated, mHealth-enabled strategies to enhance the management of stroke and other chronic diseases in resource-limited settings. Clinical Trial: ClinicalTrials.gov NCT03185858/NCT05792618
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