Costs and cost-effectiveness analyses of mCARE strategies for promoting care seeking of maternal and newborn health services in rural Bangladesh

We examined the incremental cost-effectiveness between two mHealth programs, implemented from 2011 to 2015 in rural Bangladesh: (1) Comprehensive mCARE package as an intervention group and (2) Basic mCARE package as a control group. Both programs included a core package of census enumeration and pre...

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Vydáno v:	PloS one Ročník 14; číslo 10; s. e0223004
Hlavní autoři:	Jo, Youngji, LeFevre, Amnesty E., Healy, Katherine, Singh, Neelu, Alland, Kelsey, Mehra, Sucheta, Ali, Hasmot, Shaikh, Saijuddin, Haque, Rezawanul, Christian, Parul, Labrique, Alain B.
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States Public Library of Science 01.10.2019 Public Library of Science (PLoS)
Témata:	Adolescent Adult Bangladesh - epidemiology BASIC (programming language) Cellular telephones Communities Community health aides Computer and Information Sciences Computer simulation Control methods Cost analysis Cost assessments Cost benefit analysis Costs Delivery of Health Care - economics Economic impact Electronic surveillance Engineering and Technology Enumeration Fatalities Female Gross domestic product Health aspects Health care industry Health promotion Health services Health Services - economics Health Services - standards Health surveillance House Calls Humans Infant care Infant Health - economics Infant Health - standards Infant mortality Infant, Newborn Intelligence gathering Medical personnel Medicine and Health Sciences Middle Aged Monte Carlo methods Monte Carlo simulation Mortality Newborn babies Newborn infants Patient Acceptance of Health Care People and Places Pilot projects Planning Postnatal Care - economics Postnatal Care - standards Pregnancy Pregnant women Public health Research and Analysis Methods Rural areas Rural Population Sensitivity analysis Short message service SMS (Short messaging service) Social Sciences Statistical analysis Surveillance Surveillance equipment Systematic review Text messaging Uncertainty Womens health Workers Young Adult Bangladesh Uganda Kenya United States > US Maryland Baltimore Maryland
ISSN:	1932-6203, 1932-6203
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Shrnutí:	We examined the incremental cost-effectiveness between two mHealth programs, implemented from 2011 to 2015 in rural Bangladesh: (1) Comprehensive mCARE package as an intervention group and (2) Basic mCARE package as a control group. Both programs included a core package of census enumeration and pregnancy surveillance provided by an established cadre of digitally enabled community health workers (CHWs). In the comprehensive mCARE package, short message service (SMS) and home visit reminders were additionally sent to pregnant women (n = 610) and CHWs (n = 70) to promote the pregnant women's care-seeking of essential maternal and newborn care services. Economic costs were assessed from a program perspective inclusive of development, start-up, and implementation phases. Effects were calculated as disability adjusted life years (DALYs) and the number of newborn deaths averted. For comparative purposes, we normalized our evaluation to estimate total costs and total newborn deaths averted per 1 million people in a community for both groups. Uncertainty was assessed using probabilistic sensitivity analyses with Monte Carlo simulation. The addition of SMS and home visit reminders based on a mobile phone-facilitated pregnancy surveillance system was highly cost effective at a cost per DALY averted of $31 (95% uncertainty range: $19-81). The comprehensive mCARE program had at least 88% probability of being highly cost-effective as compared to the basic mCARE program based on the threshold of Bangladesh's GDP per capita. mHealth strategies such as SMS and home visit reminders on a well-established pregnancy surveillance system may improve service utilization and program cost-effectiveness in low-resource settings.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0223004