背景:MobileLink是一种基于手机的干预措施,旨在增加对,和使用,柬埔寨女性娱乐工作者面临更高的特定疾病和基于性别的暴力风险。一项多站点随机对照试验表明,MobileLink在6个月后将女性娱乐工作者与外展工作者联系起来,以获取信息并陪同转介,但并未导致艾滋病毒和性传播感染检测的统计学显着改善。使用避孕药,和避孕套的使用。
目的:本研究旨在对MobileLink进行3部分的经济评估,以了解其成本,值,和负担能力。
方法:我们进行了成本,成本效益,以及使用来自MobileLink试验和其他来源的成本和结果数据对MobileLink进行预算影响分析。对于成本分析,我们估计了总数,每人,以及与常规护理相比,移动链接的增量成本。使用概率决策分析模型,我们通过将试验中选定的主要和次要结局转换为避免的残疾调整寿命年(DALYs),从付款人以及付款人和患者的综合角度估计了MobileLink的1年成本效益.最后,我们估计了在5年内将MobileLink的消息和外展服务扩展到70%的女性娱乐工作者的财务成本。
结果:从付款人的角度来看,MobileLink的增量成本为199美元,从付款人和患者的综合角度来看,每人为195美元。平均为0.018(95%的预测区间-0.088至0.126)的DALYs避免,从付款人的角度来看,MobileLink的成本效益为每DALY10,955美元(从付款人和患者的角度来看,每DALY为10,755美元)。移动链接的成本必须降低85%,或者它的有效性必须高出5.56倍,干预措施达到柬埔寨建议的成本效益阈值的上限(每DALY避免1671美元)。将MobileLink扩展到34,790名女性娱乐工作者的5年成本估计为每人每年164万美元或46美元。
结论:本研究对MobileLink进行了全面的经济评估。我们发现,除非成本降低或有效性提高,否则MobileLink不太可能具有成本效益。据估计,将移动链接扩展到更多女性娱乐工作者的成本低于试验成本。鉴于将女性娱乐工作者与基本服务联系起来的重要性,未来的研究应集中在提高MobileLink的有效性或为该人群开发新的移动健康干预措施上。
背景:ClinicalTrials.govNCT03117842;https://clinicaltrials.gov/study/NCT03117842。
BACKGROUND: Mobile Link is a mobile phone-based intervention to increase access to, and use of, health care services among female entertainment workers in Cambodia who face higher risks for specific diseases and gender-based violence. A multisite randomized controlled trial showed that Mobile Link connected female entertainment workers with outreach workers for information and escorted referrals after 6 months but did not lead to statistically significant improvements in HIV and sexually transmitted infection testing, contraceptive use, and condom use.
OBJECTIVE: This study aims to conduct a 3-part economic evaluation of Mobile Link to understand its costs, value, and affordability.
METHODS: We conducted cost, cost-effectiveness, and budget impact analyses of Mobile Link using cost and outcomes data from the Mobile Link trial and other sources. For the cost analysis, we estimated the total, per-person, and incremental costs of Mobile Link compared with usual care. Using probabilistic decision-analytic models, we estimated the 1-year cost-effectiveness of Mobile Link from payer and combined payer and patient perspectives by converting selected primary and secondary outcomes from the trial to disability-adjusted life years (DALYs) averted. Finally, we estimated the financial costs of scaling up Mobile Link\'s messaging and outreach services to 70% of female entertainment workers in 5 years.
RESULTS: The incremental costs of Mobile Link were US $199 from a payer perspective and US $195 per person from a combined payer and patient perspective. With an average of 0.018 (95% predicted interval -0.088 to 0.126) DALYs averted, Mobile Link\'s cost-effectiveness was US $10,955 per DALY from a payer perspective (US $10,755 per DALY averted from a payer and patient perspective). The costs of Mobile Link would have to decrease by 85%, or its effectiveness would have to be 5.56 times higher, for the intervention to meet the upper limit of recommended cost-effectiveness thresholds in Cambodia (US $1671 per DALY averted). The 5-year cost of scaling Mobile Link to 34,790 female entertainment workers was estimated at US $1.64 million or US $46 per person per year.
CONCLUSIONS: This study provided a comprehensive economic evaluation of Mobile Link. We found that Mobile Link is not likely to be cost-effective unless its costs decrease or its effectiveness increases. Scaling up Mobile Link to more female entertainment workers is estimated to cost less than the costs of the trial. Given the importance of linking female entertainment workers to essential services, future research should focus on enhancing the effectiveness of Mobile Link or developing new mobile health interventions for this population.
BACKGROUND: ClinicalTrials.gov NCT03117842; https://clinicaltrials.gov/study/NCT03117842.