A Mobile Phone–Based Support Intervention to Increase Use of Postabortion Family Planning in Cambodia: Cost-Effectiveness Evaluation

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Abstract

Background

Despite progress over the last decade, there is a continuing unmet need for contraception in Cambodia. Interventions delivered by mobile phone could help increase uptake and continuation of contraception, particularly among hard-to-reach populations, by providing interactive personalized support inexpensively wherever the person is located and whenever needed.

Objective

The objective of this study was to evaluate the cost-effectiveness of mobile phone–based support added to standard postabortion family planning care in Cambodia, according to the results of the MOTIF (MObile Technology for Improved Family planning) trial.

Methods

A model was created to estimate the costs and effects of the intervention versus standard care. We adopted a societal perspective when estimating costs, including direct and indirect costs for users. The incremental cost-effectiveness ratio was calculated for the base case, as well as a deterministic and probabilistic sensitivity analysis, which we compared against a range of likely cost-effectiveness thresholds.

Results

The incremental cost of mobile phone–based support was estimated to be an additional US $8160.49 per 1000 clients, leading to an estimated 518 couple-years of protection (CYPs) gained per 1000 clients and 99 disability-adjusted life-years (DALYs) averted. The incremental cost-effectiveness ratio was US $15.75 per additional CYP and US $82.57 per DALY averted. The model was most sensitive to personnel and mobile service costs. Assuming a range of cost-effectiveness thresholds from US $58 to US $176 for Cambodia, the probability of the intervention being cost-effective ranged from 11% to 95%.

Conclusions

This study demonstrates that the cost-effectiveness of the intervention delivered by mobile phone assessed in the MOTIF trial lies within the estimated range of the cost-effectiveness threshold for Cambodia. When assessing value in interventions to improve the uptake and adherence of family planning services, the use of interactive mobile phone messaging and counselling for women who have had an abortion should be considered as an option by policy makers.

Trial Registration

ClinicalTrials.gov NCT01823861; https://clinicaltrials.gov/ct2/show/NCT01823861

Related collections

Most cited references 19

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The cost-effectiveness of smoking cessation support delivered by mobile phone text messaging: Txt2stop

Carla Guerriero, John Cairns, Ian Roberts … (2012)

Background The txt2stop trial has shown that mobile-phone-based smoking cessation support doubles biochemically validated quitting at 6 months. This study examines the cost-effectiveness of smoking cessation support delivered by mobile phone text messaging. Methods The lifetime incremental costs and benefits of adding text-based support to current practice are estimated from a UK NHS perspective using a Markov model. The cost-effectiveness was measured in terms of cost per quitter, cost per life year gained and cost per QALY gained. As in previous studies, smokers are assumed to face a higher risk of experiencing the following five diseases: lung cancer, stroke, myocardial infarction, chronic obstructive pulmonary disease, and coronary heart disease (i.e. the main fatal or disabling, but by no means the only, adverse effects of prolonged smoking). The treatment costs and health state values associated with these diseases were identified from the literature. The analysis was based on the age and gender distribution observed in the txt2stop trial. Effectiveness and cost parameters were varied in deterministic sensitivity analyses, and a probabilistic sensitivity analysis was also performed. Findings The cost of text-based support per 1,000 enrolled smokers is £16,120, which, given an estimated 58 additional quitters at 6 months, equates to £278 per quitter. However, when the future NHS costs saved (as a result of reduced smoking) are included, text-based support would be cost saving. It is estimated that 18 LYs are gained per 1,000 smokers (0.3 LYs per quitter) receiving text-based support, and 29 QALYs are gained (0.5 QALYs per quitter). The deterministic sensitivity analysis indicated that changes in individual model parameters did not alter the conclusion that this is a cost-effective intervention. Similarly, the probabilistic sensitivity analysis indicated a >90 % chance that the intervention will be cost saving. Interpretation This study shows that under a wide variety of conditions, personalised smoking cessation advice and support by mobile phone message is both beneficial for health and cost saving to a health system.

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Mobile Phone Interventions for Adolescent Sexual and Reproductive Health: A Systematic Review.

Kelly L'Engle, Emily Mangone, Angela Parcesepe … (2016)

Interventions for adolescent sexual and reproductive health (ASRH) are increasingly using mobile phones but may not effectively report evidence.

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Using daily text-message reminders to improve adherence with oral contraceptives: a randomized controlled trial.

Simon Goldberg, E Kavanagh, Shelley Hurwitz … (2010)

To estimate whether women receiving daily text-message reminders have increased oral contraceptive pill adherence compared with women not receiving reminders. This randomized controlled trial estimated whether there was an effect of daily text-message reminders on oral contraceptive pill adherence of new oral contraceptive pill users. Pill-taking was tracked for 3 months by an electronic monitoring device with wireless data collection. During the study period, participants assigned the intervention received a daily reminder text message. Eighty-two women were assigned randomly to detect a 1.6+/-2.0 pill difference (90% power, 5% alpha, 15% dropout). Participants were 79% white, non-Hispanic, 99% high school graduates, and 99% nulliparous with a mean age of 22 years. Most reported condom use with past coital activity, and more than half reported prior emergency contraception use. The mean number of missed pills per cycle did not differ significantly between the groups: 4.9+/-3.0 for the text-message group and 4.6+/-3.5 for the control group (P=.60). The number of missed pills per cycle increased over the course of the study, but this pattern did not increase differentially between the groups. Adherence recorded by the electronic monitoring device indicated much poorer adherence than that recorded by patient diaries. Despite poor pill-taking, there were no pregnancies. Daily text-message reminders did not improve oral contraceptive pill adherence. Although the lack of benefit may be attributed to the frequent use of alternative reminder systems in the control group, the rate of missed pills when measured objectively was still very high in both groups. Clinicaltrials.gov, www.clinicaltrials.gov, NCT00733707. I.

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Author and article information

Contributors

Chris Smith:

ORCID: https://orcid.org/0000-0001-9238-3202

Graduate School of Tropical Medicine and Global HealthNagasaki University1-12-4, SakamotoNagasaki-shi, 852-8523Japan81 8087105309christopher.smith@lshtm.ac.uk

Journal

Journal ID (nlm-ta): JMIR Mhealth Uhealth

Journal ID (iso-abbrev): JMIR Mhealth Uhealth

Journal ID (publisher-id): JMU

Title: JMIR mHealth and uHealth

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 2291-5222

Publication date Collection: February 2020

Publication date (Electronic): 25 February 2020

Volume: 8

Issue: 2

Electronic Location Identifier: e16276

Affiliations

[1 ] Department of Global Health and Development London School of Hygiene and Tropical Medicine London United Kingdom

[2 ] Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine London United Kingdom

[3 ] Department of Population Health London School of Hygiene and Tropical Medicine London United Kingdom

[4 ] Graduate School of Tropical Medicine and Global Health Nagasaki University Nagasaki-shi Japan

[5 ] Department of Clinical Research London School of Tropical Medicine London United Kingdom

Author notes

Corresponding Author: Chris Smith christopher.smith@ 123456lshtm.ac.uk

Author information

Jeremy Hill https://orcid.org/0000-0002-3749-6519

Jourdan McGinn https://orcid.org/0000-0003-2202-5500

John Cairns https://orcid.org/0000-0001-6442-0440

Caroline Free https://orcid.org/0000-0003-1711-0006

Chris Smith https://orcid.org/0000-0001-9238-3202

Article

Publisher ID: v8i2e16276

DOI: 10.2196/16276

PMC ID: 7064963

PubMed ID: 32130166

SO-VID: edc25bc1-2b90-4351-9574-9f10349aff58

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mHealth and uHealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.

History

Date received : 16 September 2019

Date revision requested : 8 October 2019

Date revision received : 29 October 2019

Date accepted : 16 December 2019

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