TY - JOUR
T1 - MCARE, a digital health intervention package on pregnancy surveillance and care-seeking reminders from 2018 to 2027 in Bangladesh
T2 - A model-based cost-effectiveness analysis
AU - Jo, Youngji
AU - Lefevre, Amnesty Elizabeth
AU - Ali, Hasmot
AU - Mehra, Sucheta
AU - Alland, Kelsey
AU - Shaikh, Saijuddin
AU - Haque, Rezwanul
AU - Pak, Esther Semee
AU - Chowdhury, Mridul
AU - Labrique, Alain B.
N1 - Funding Information:
Contributors ABL is the principal investigator. YJ, AEL and ABL designed the study and data collection instruments. SM, HA, SS, RH, MC and KA oversaw the data collection and quantitative data entry. YJ trained a data collection team, analysed data and wrote the first draft of the manuscript. AEL, ABL and ESP provided comprehensive reviews and comments. All authors contributed and provided critical comments for the final manuscript. Funding This work was supported by the UBS Optimus Foundation (Grant No. 11053414). Competing interests None declared.
Publisher Copyright:
© BMJ Publishing Group Limited 2021.
PY - 2021/4/1
Y1 - 2021/4/1
N2 - Objective We estimated the cost-effectiveness of a digital health intervention package (mCARE) for community health workers, on pregnancy surveillance and care-seeking reminders compared with the existing paper-based status quo, from 2018 to 2027, in Bangladesh. Interventions The mCARE programme involved digitally enhanced pregnancy surveillance, individually targeted text messages and in-person home-visit to pregnant women for care-seeking reminders for antenatal care, child delivery and postnatal care. Study design We developed a model to project population and service coverage increases with annual geographical expansion (from 1 million to 10 million population over 10 years) of the mCARE programme and the status quo. Major outcomes For this modelling study, we used Lives Saved Tool to estimate the number of deaths and disability-adjusted life years (DALYs) that would be averted by 2027, if the coverage of health interventions was increased in mCARE programme and the status quo, respectively. Economic costs were captured from a societal perspective using an ingredients approach and expressed in 2018 US dollars. Probabilistic sensitivity analysis was undertaken to account for parameter uncertainties. Results We estimated the mCARE programme to avert 3076 deaths by 2027 at an incremental cost of $43 million relative to the status quo, which is translated to $462 per DALY averted. The societal costs were estimated to be $115 million for mCARE programme (48% of which are programme costs, 35% user costs and 17% provider costs). With the continued implementation and geographical scaling-up, the mCARE programme improved its cost-effectiveness from $1152 to $462 per DALY averted from 5 to 10 years. Conclusion Mobile phone-based pregnancy surveillance systems with individually scheduled text messages and home-visit reminder strategies can be highly cost-effective in Bangladesh. The cost-effectiveness may improve as it promotes facility-based child delivery and achieves greater programme cost efficiency with programme scale and sustainability.
AB - Objective We estimated the cost-effectiveness of a digital health intervention package (mCARE) for community health workers, on pregnancy surveillance and care-seeking reminders compared with the existing paper-based status quo, from 2018 to 2027, in Bangladesh. Interventions The mCARE programme involved digitally enhanced pregnancy surveillance, individually targeted text messages and in-person home-visit to pregnant women for care-seeking reminders for antenatal care, child delivery and postnatal care. Study design We developed a model to project population and service coverage increases with annual geographical expansion (from 1 million to 10 million population over 10 years) of the mCARE programme and the status quo. Major outcomes For this modelling study, we used Lives Saved Tool to estimate the number of deaths and disability-adjusted life years (DALYs) that would be averted by 2027, if the coverage of health interventions was increased in mCARE programme and the status quo, respectively. Economic costs were captured from a societal perspective using an ingredients approach and expressed in 2018 US dollars. Probabilistic sensitivity analysis was undertaken to account for parameter uncertainties. Results We estimated the mCARE programme to avert 3076 deaths by 2027 at an incremental cost of $43 million relative to the status quo, which is translated to $462 per DALY averted. The societal costs were estimated to be $115 million for mCARE programme (48% of which are programme costs, 35% user costs and 17% provider costs). With the continued implementation and geographical scaling-up, the mCARE programme improved its cost-effectiveness from $1152 to $462 per DALY averted from 5 to 10 years. Conclusion Mobile phone-based pregnancy surveillance systems with individually scheduled text messages and home-visit reminder strategies can be highly cost-effective in Bangladesh. The cost-effectiveness may improve as it promotes facility-based child delivery and achieves greater programme cost efficiency with programme scale and sustainability.
KW - health economics
KW - information technology
KW - public health
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U2 - 10.1136/bmjopen-2020-042553
DO - 10.1136/bmjopen-2020-042553
M3 - Article
C2 - 33795294
AN - SCOPUS:85103720236
SN - 2044-6055
VL - 11
JO - BMJ open
JF - BMJ open
IS - 4
M1 - e042553
ER -