Economic evaluation of mobile phone text message interventions to improve adherence to HIV therapy in Kenya

Anik R. Patel, Jason Kessler, R. Scott Braithwaite, Kimberly A. Nucifora, Harsha Thirumurthy, Qinlian Zhou, Richard T. Lester, Carlo A. Marra

Research output: Contribution to journalArticle

  • 2 Citations

Abstract

Background: A surge in mobile phone availability has fueled low cost short messaging service (SMS) adherence interventions. Multiple systematic reviews have concluded that some SMS-based interventions are effective at improving antiretroviral therapy (ART) adherence, and they are hypothesized to improve retention in care. The objective of this study was to evaluate the costeffectiveness of SMS-based adherence interventions and explore the added value of retention benefits. Methods: We evaluated the cost-effectiveness of weekly SMS interventions compared to standard care among HIV+ individuals initiating ART for the first time in Kenya. We used an individual level micro-simulation model populated with data from two SMSintervention trials, an East-African HIV+ cohort and published literature. We estimated average quality adjusted life years (QALY) and lifetime HIV-related costs from a healthcare perspective. We explored a wide range of scenarios and assumptions in one-way and multivariate sensitivity analyses. Results: We found that SMS-based adherence interventions were cost-effective by WHO standards, with an incremental costeffectiveness ratio (ICER) of $1,037/QALY. In the secondary analysis, potential retention benefits improved the cost-effectiveness of SMS intervention (ICER=$864/QALY). In multivariate sensitivity analyses, the interventions remained cost-effective in most analyses, but the ICER was highly sensitive to intervention costs, effectiveness and average cohort CD4 count at ART initiation. SMS interventions remained cost-effective in a test and treat scenario where individuals were assumed to initiate ART upon HIV detection. Conclusions: Effective SMS interventions would likely increase the efficiency of ART programs by improving HIV treatment outcomes at relatively low costs, and they could facilitate achievement of the UNAIDS goal of 90% viral suppression among those on ART by 2020.

LanguageEnglish (US)
Article numbere6078
JournalMedicine (United States)
Volume96
Issue number7
DOIs
StatePublished - Jan 1 2017

Fingerprint

Text Messaging
Cell Phones
Kenya
Cost-Benefit Analysis
HIV
Quality-Adjusted Life Years
Costs and Cost Analysis
Therapeutics
Multivariate Analysis
CD4 Lymphocyte Count
Health Care Costs
Efficiency

Keywords

  • Cost-effectiveness
  • Drug adherence
  • HIV
  • Implementation science
  • MHealth
  • Mobile phone
  • SMS

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Patel, A. R., Kessler, J., Braithwaite, R. S., Nucifora, K. A., Thirumurthy, H., Zhou, Q., ... Marra, C. A. (2017). Economic evaluation of mobile phone text message interventions to improve adherence to HIV therapy in Kenya. Medicine (United States), 96(7), [e6078]. DOI: 10.1097/MD.0000000000006078

Economic evaluation of mobile phone text message interventions to improve adherence to HIV therapy in Kenya. / Patel, Anik R.; Kessler, Jason; Braithwaite, R. Scott; Nucifora, Kimberly A.; Thirumurthy, Harsha; Zhou, Qinlian; Lester, Richard T.; Marra, Carlo A.

In: Medicine (United States), Vol. 96, No. 7, e6078, 01.01.2017.

Research output: Contribution to journalArticle

Patel, AR, Kessler, J, Braithwaite, RS, Nucifora, KA, Thirumurthy, H, Zhou, Q, Lester, RT & Marra, CA 2017, 'Economic evaluation of mobile phone text message interventions to improve adherence to HIV therapy in Kenya' Medicine (United States), vol. 96, no. 7, e6078. DOI: 10.1097/MD.0000000000006078
Patel, Anik R. ; Kessler, Jason ; Braithwaite, R. Scott ; Nucifora, Kimberly A. ; Thirumurthy, Harsha ; Zhou, Qinlian ; Lester, Richard T. ; Marra, Carlo A./ Economic evaluation of mobile phone text message interventions to improve adherence to HIV therapy in Kenya. In: Medicine (United States). 2017 ; Vol. 96, No. 7.
@article{58d1625495574b0684393b6711fb7176,
title = "Economic evaluation of mobile phone text message interventions to improve adherence to HIV therapy in Kenya",
abstract = "Background: A surge in mobile phone availability has fueled low cost short messaging service (SMS) adherence interventions. Multiple systematic reviews have concluded that some SMS-based interventions are effective at improving antiretroviral therapy (ART) adherence, and they are hypothesized to improve retention in care. The objective of this study was to evaluate the costeffectiveness of SMS-based adherence interventions and explore the added value of retention benefits. Methods: We evaluated the cost-effectiveness of weekly SMS interventions compared to standard care among HIV+ individuals initiating ART for the first time in Kenya. We used an individual level micro-simulation model populated with data from two SMSintervention trials, an East-African HIV+ cohort and published literature. We estimated average quality adjusted life years (QALY) and lifetime HIV-related costs from a healthcare perspective. We explored a wide range of scenarios and assumptions in one-way and multivariate sensitivity analyses. Results: We found that SMS-based adherence interventions were cost-effective by WHO standards, with an incremental costeffectiveness ratio (ICER) of $1,037/QALY. In the secondary analysis, potential retention benefits improved the cost-effectiveness of SMS intervention (ICER=$864/QALY). In multivariate sensitivity analyses, the interventions remained cost-effective in most analyses, but the ICER was highly sensitive to intervention costs, effectiveness and average cohort CD4 count at ART initiation. SMS interventions remained cost-effective in a test and treat scenario where individuals were assumed to initiate ART upon HIV detection. Conclusions: Effective SMS interventions would likely increase the efficiency of ART programs by improving HIV treatment outcomes at relatively low costs, and they could facilitate achievement of the UNAIDS goal of 90{\%} viral suppression among those on ART by 2020.",
keywords = "Cost-effectiveness, Drug adherence, HIV, Implementation science, MHealth, Mobile phone, SMS",
author = "Patel, {Anik R.} and Jason Kessler and Braithwaite, {R. Scott} and Nucifora, {Kimberly A.} and Harsha Thirumurthy and Qinlian Zhou and Lester, {Richard T.} and Marra, {Carlo A.}",
year = "2017",
month = "1",
day = "1",
doi = "10.1097/MD.0000000000006078",
language = "English (US)",
volume = "96",
journal = "Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries",
issn = "0025-7974",
publisher = "Lippincott Williams and Wilkins",
number = "7",

}

TY - JOUR

T1 - Economic evaluation of mobile phone text message interventions to improve adherence to HIV therapy in Kenya

AU - Patel,Anik R.

AU - Kessler,Jason

AU - Braithwaite,R. Scott

AU - Nucifora,Kimberly A.

AU - Thirumurthy,Harsha

AU - Zhou,Qinlian

AU - Lester,Richard T.

AU - Marra,Carlo A.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background: A surge in mobile phone availability has fueled low cost short messaging service (SMS) adherence interventions. Multiple systematic reviews have concluded that some SMS-based interventions are effective at improving antiretroviral therapy (ART) adherence, and they are hypothesized to improve retention in care. The objective of this study was to evaluate the costeffectiveness of SMS-based adherence interventions and explore the added value of retention benefits. Methods: We evaluated the cost-effectiveness of weekly SMS interventions compared to standard care among HIV+ individuals initiating ART for the first time in Kenya. We used an individual level micro-simulation model populated with data from two SMSintervention trials, an East-African HIV+ cohort and published literature. We estimated average quality adjusted life years (QALY) and lifetime HIV-related costs from a healthcare perspective. We explored a wide range of scenarios and assumptions in one-way and multivariate sensitivity analyses. Results: We found that SMS-based adherence interventions were cost-effective by WHO standards, with an incremental costeffectiveness ratio (ICER) of $1,037/QALY. In the secondary analysis, potential retention benefits improved the cost-effectiveness of SMS intervention (ICER=$864/QALY). In multivariate sensitivity analyses, the interventions remained cost-effective in most analyses, but the ICER was highly sensitive to intervention costs, effectiveness and average cohort CD4 count at ART initiation. SMS interventions remained cost-effective in a test and treat scenario where individuals were assumed to initiate ART upon HIV detection. Conclusions: Effective SMS interventions would likely increase the efficiency of ART programs by improving HIV treatment outcomes at relatively low costs, and they could facilitate achievement of the UNAIDS goal of 90% viral suppression among those on ART by 2020.

AB - Background: A surge in mobile phone availability has fueled low cost short messaging service (SMS) adherence interventions. Multiple systematic reviews have concluded that some SMS-based interventions are effective at improving antiretroviral therapy (ART) adherence, and they are hypothesized to improve retention in care. The objective of this study was to evaluate the costeffectiveness of SMS-based adherence interventions and explore the added value of retention benefits. Methods: We evaluated the cost-effectiveness of weekly SMS interventions compared to standard care among HIV+ individuals initiating ART for the first time in Kenya. We used an individual level micro-simulation model populated with data from two SMSintervention trials, an East-African HIV+ cohort and published literature. We estimated average quality adjusted life years (QALY) and lifetime HIV-related costs from a healthcare perspective. We explored a wide range of scenarios and assumptions in one-way and multivariate sensitivity analyses. Results: We found that SMS-based adherence interventions were cost-effective by WHO standards, with an incremental costeffectiveness ratio (ICER) of $1,037/QALY. In the secondary analysis, potential retention benefits improved the cost-effectiveness of SMS intervention (ICER=$864/QALY). In multivariate sensitivity analyses, the interventions remained cost-effective in most analyses, but the ICER was highly sensitive to intervention costs, effectiveness and average cohort CD4 count at ART initiation. SMS interventions remained cost-effective in a test and treat scenario where individuals were assumed to initiate ART upon HIV detection. Conclusions: Effective SMS interventions would likely increase the efficiency of ART programs by improving HIV treatment outcomes at relatively low costs, and they could facilitate achievement of the UNAIDS goal of 90% viral suppression among those on ART by 2020.

KW - Cost-effectiveness

KW - Drug adherence

KW - HIV

KW - Implementation science

KW - MHealth

KW - Mobile phone

KW - SMS

UR - http://www.scopus.com/inward/record.url?scp=85013664385&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85013664385&partnerID=8YFLogxK

U2 - 10.1097/MD.0000000000006078

DO - 10.1097/MD.0000000000006078

M3 - Article

VL - 96

JO - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

T2 - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

JF - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

SN - 0025-7974

IS - 7

M1 - e6078

ER -