Forecasting the Value for Money of Mobile Maternal Health Information Messages on Improving Utilization of Maternal and Child Health Services in Gauteng, South Africa: Cost-Effectiveness Analysis.
No Thumbnail Available
Date
0000-00-00
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
BACKGROUND Limited evidence exists on the value for money of mHealth information programs in low resource settings OBJECTIVE This study sought to model the incremental cost effectiveness of gradually scaling up text messaging services to pregnant women throughout Gauteng province South Africa from 2012 to 2017 METHODS Data collection occurred as part of a retrospective study in 6 health centers in Gauteng province Stage based short message service SMS text messages on maternal health were sent to pregnant women twice per week during pregnancy and continued until the infant s first birthday Program costs incremental costs to users and the health system costs for these women were measured along with changes in the utilization of antenatal care visits and childhood immunizations and compared with those from a control group of pregnant women who received no SMS text messages Incremental changes in utilization were entered into the Lives Saved Tool and used to forecast lives saved and disability adjusted life years DALYs averted by scaling up program activities over 5 years to reach 60 of pregnant women across Gauteng province Uncertainty was characterized using one way and probabilistic uncertainty analyses RESULTS Five year program costs were estimated to be US 1 2 million 17 of which were incurred by costs on program development and 31 on SMS text message delivery costs Costs to users were US 1 66 to attend clinic based services nearly 90 of which was attributed to wages lost Costs to the health system included provider time costs to register users US 0 08 and to provide antenatal care US 4 36 and postnatal care US 3 08 services Incremental costs per DALY averted from a societal perspective ranged from US 1985 in the first year of implementation to US 200 in the 5th year At a willingness to pay threshold of US 2000 the project had a 40 probability of being cost effective in year 1 versus 100 in all years thereafter CONCLUSIONS Study findings suggest that delivering SMS text messages on maternal health information to pregnant and postpartum women may be a cost effective strategy for bolstering antenatal care and childhood immunizations even at very small margins of coverage increases Primary data obtained prospectively as part of more rigorous study designs are needed to validate modeled results