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What is the DALY Cost-Effectiveness of mHealth CVD Programs?

By Guest Writer on October 20, 2021

mhealth cost-effectiveness

Cardiovascular diseases (CVD) are the leading cause of death in Indonesia, and there are large disparities in access to recommended preventative treatments across the country, particularly in rural areas. People generally only seek primary care when urgently required, but with non-communicable diseases, this can often be too late.

Technology-enabled CVD screening and management led by community health workers have been shown to be effective in better managing those at high risk of CVD in a rural Indonesian population

SMARThealth Program in Indonesia

SMARThealth provides village health workers (locally known as kader) with training on blood sample collection, a smart phone to aid assessment and data collection, alongside specific cardiovascular care guidance. Health workers then share the data with qualified health professionals – resulting in a radical shift in healthcare delivery and improved cardiovascular care.

After being diagnosed as high risk by SMARThealth, 57% of people were using blood pressure medication. This compares to rates of just 16% in villages that didn’t receive the intervention. A further 15.5% of high risk individuals in the SMARThealth villages were using the most effective combination of medications, compared with just 1% in the control villages.

However, the economic impacts of implementing the SMARThealth intervention were unknown.

mHealth Cost-Effectiveness Analysis

The research paper, “Cost-effectiveness of a mobile technology-enabled primary care intervention for cardiovascular disease risk management in rural Indonesia,” conducted a modelled cost-effectiveness analysis of the SMARThealth intervention in rural villages of Malang district, Indonesia from the payer perspective over a 10-year period.

A Markov model was designed and populated with epidemiological and cost data collected in a recent quasi-randomized trial, with nine health states representing a differing risk for experiencing a major CVD event.

Disability-Adjusted Life Years (DALYs) were estimated for the intervention and usual care using disability weights from the literature for major CVD events. Annual treatment costs for CVD treatment and prevention were $US83 under current care and $US144 for those receiving the intervention.

The intervention had an incremental cost-effectiveness ratio of $4,288 per DALY averted and $3,681 per major CVD event avoided relative to usual care.

mHealth is Cost-Effective for CVD

One-way and probabilistic sensitivity analyses demonstrated that the results were robust to plausible variations in model parameters and that the intervention is highly likely to be considered cost-effective by decision-makers across a range of potentially acceptable willingness to pay levels.

Relative to current care, the intervention was a cost-effective means to improve the management of CVD in this rural Indonesian population. Further scale-up of the intervention offers the prospect of significant gains in population health and sustainable progress toward universal health coverage for the Indonesian population.

A lightly edited version of Cost-effectiveness of a mobile technology-enabled primary care intervention for cardiovascular disease risk management in rural Indonesia by Blake Angell, Thomas Lung, Devarsetty Praveen, Asri Maharani, Sujarwoto Sujarwoto, Anna Palagyi, Delvac Oceandy, Gindo Tampubolon, Anushka Patel, Stephen Jan

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