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

Jeremy Hill, Jourdan McGinn, John Cairns, Caroline Free, Chris Smith, Jeremy Hill, Jourdan McGinn, John Cairns, Caroline Free, Chris Smith

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://ichgcp.net/clinical-trials-registry/NCT01823861.

Keywords: Cambodia; contraception; cost-effectiveness; digital health; mHealth; postabortion contraception; postabortion family planning.

Conflict of interest statement

Conflicts of Interest: None declared.

©Jeremy Hill, Jourdan McGinn, John Cairns, Caroline Free, Chris Smith. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 25.02.2020.

Figures

Figure 1
Figure 1
Conceptual framework for the service provision model based on the MOTIF trial. Inputs from the MOTIF trial are shown in green. Models used to derive costs and effects are shown in yellow. IUD: intrauterine device; MOTIF: MObile Technology for Improved Family planning; OCP: oral contraceptive pill.
Figure 2
Figure 2
Marie Stopes International Impact2 model framework. Inputs, outputs, and processes used in the Impact2 model are illustrated, as they apply to this study. Green: inputs to the model from the MOTIF trial. Yellow: effects reported in this study. Adapted from Weinberger et al [21]. CYPs: couple-years of protection; DALYs: disability-adjusted life-years; LAM: long-acting method; MOTIF: MObile Technology for Improved Family planning.
Figure 3
Figure 3
Tornado plot of deterministic sensitivity analysis using MOTIF intervention model parameters. For each parameter, the ICER was recalculated taking the upper and then lower deterministic range value. ICER ranges are centered on the ICER point estimate of US $82.57 per DALY averted. DALYs: disability-adjusted life-years; ICER: incremental cost-effectiveness ratio; IUD: intrauterine device; MOTIF: MObile Technology for Improved Family planning; MSIC: Marie Stopes International Cambodia; OC: oral contraceptive.
Figure 4
Figure 4
Monte-Carlo simulation results plotted on the cost-effectiveness plane, with effects measured in DALYs averted. Linear demarcations of the upper and lower bounds for the cost-effectiveness threshold for DALYs averted are included for comparison. DALYs: disability-adjusted life-years; MOTIF: MObile Technology for Improved Family planning.
Figure 5
Figure 5
Monte-Carlo simulation results plotted on the cost-effectiveness plane, with effects measured in CYPs. CYPs: couple-years of protection.
Figure 6
Figure 6
Cost-effectiveness acceptability curve derived from Monte-Carlo simulations of MOTIF intervention results, with effects measured in DALYs averted. DALYs: disability-adjusted life-years; MOTIF: MObile Technology for Improved Family planning.
Figure 7
Figure 7
Cost-effectiveness acceptability curve derived from Monte-Carlo simulations of MOTIF intervention results, with effects measured in CYPs averted. CYPs: couple-years of protection; MOTIF: MObile Technology for Improved Family planning.

References

    1. Cleland J, Conde-Agudelo A, Peterson H, Ross J, Tsui A. Contraception and health. Lancet. 2012 Jul 14;380(9837):149–56. doi: 10.1016/S0140-6736(12)60609-6.
    1. Singh S, Darroch JE, Ashford LS. Guttmacher Institute. New York: Guttmacher Institute; 2014. [2020-01-26]. Adding It Up 2014: The Costs and Benefits of Investing in Sexual and Reproductive Health .
    1. National Institute of Statistics/Cambodia. Directorate General for Health/Cambodia. ICF International . The DHS Program. Phnom Penh, Cambodia: National Institute of Statistics/Cambodia, Directorate General for Health/Cambodia, and ICF International; 2015. [2020-01-26]. Cambodia Demographic and Health Survey 2014 .
    1. Fetters T, Samandari G. Abortion incidence in Cambodia, 2005 and 2010. Glob Public Health. 2015;10(4):532–44. doi: 10.1080/17441692.2014.992453.
    1. Källander K, Tibenderana JK, Akpogheneta OJ, Strachan DL, Hill Z, Asbroek AA, Conteh L, Kirkwood BR, Meek SR. Mobile health (mHealth) approaches and lessons for increased performance and retention of community health workers in low- and middle-income countries: a review. J Med Internet Res. 2013;15(1):e17. doi: 10.2196/jmir.2130.
    1. Free C, Phillips G, Galli L, Watson L, Felix L, Edwards P, Patel V, Haines A. The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS Med. 2013;10(1):e1001362. doi: 10.1371/journal.pmed.1001362.
    1. Castaño PM, Bynum JY, Andrés R, Lara M, Westhoff C. Effect of daily text messages on oral contraceptive continuation: a randomized controlled trial. Obstet Gynecol. 2012 Jan;119(1):14–20. doi: 10.1097/AOG.0b013e31823d4167.
    1. Hou MY, Hurwitz S, Kavanagh E, Fortin J, Goldberg AB. Using daily text-message reminders to improve adherence with oral contraceptives: a randomized controlled trial. Obstet Gynecol. 2010 Sep;116(3):633–40. doi: 10.1097/AOG.0b013e3181eb6b0f.
    1. L'Engle KL, Mangone ER, Parcesepe AM, Agarwal S, Ippoliti NB. Mobile Phone Interventions for Adolescent Sexual and Reproductive Health: A Systematic Review. Pediatrics. 2016 Sep;138(3) doi: 10.1542/peds.2016-0884.
    1. Smith C, Gold J, Ngo TD, Sumpter C, Free C. Mobile phone-based interventions for improving contraception use. Cochrane Database Syst Rev. 2015;6:CD011159. doi: 10.1002/14651858.CD011159.pub2.
    1. Smith C, Vannak U, Sokhey L, Ngo TD, Gold J, Khut K, Edwards P, Rathavy T, Free C. MObile Technology for Improved Family Planning Services (MOTIF): study protocol for a randomised controlled trial. Trials. 2013 Dec 12;14:427. doi: 10.1186/1745-6215-14-427.
    1. Ali MM, Cleland J. Contraceptive switching after method-related discontinuation: levels and differentials. Stud Fam Plann. 2010 Jun;41(2):129–33.
    1. Ali MM, Park MH, Ngo TD. Levels and determinants of switching following intrauterine device discontinuation in 14 developing countries. Contraception. 2014 Jul;90(1):47–53. doi: 10.1016/j.contraception.2014.03.008.
    1. Smith C, Ngo TD, Gold J, Edwards P, Vannak U, Sokhey L, Machiyama K, Slaymaker E, Warnock R, McCarthy O, Free C. Effect of a mobile phone-based intervention on post-abortion contraception: a randomized controlled trial in Cambodia. Bull World Health Organ. 2015 Dec 01;93(12):842–50A. doi: 10.2471/BLT.15.160267.
    1. Chiou CF, Trussell J, Reyes E, Knight K, Wallace J, Udani J, Oda K, Borenstein J. Economic analysis of contraceptives for women. Contraception. 2003 Jul;68(1):3–10. doi: 10.1016/s0010-7824(03)00078-7.
    1. Henry N, Schlueter M, Lowin J, Lekander I, Filonenko A, Trussell J, Skjeldestad FE. Cost of unintended pregnancy in Norway: a role for long-acting reversible contraception. J Fam Plann Reprod Health Care. 2014 Dec 23;41(2):109–115. doi: 10.1136/jfprhc-2014-100878.
    1. Smith C, Jarvis C, Free C. Assessing loss to follow-up in the MObile Technology for Improved Family Planning (MOTIF) randomised controlled trial. Trials. 2017 Dec 01;18(1):577. doi: 10.1186/s13063-017-2316-6.
    1. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, Bennett D, Bernabé E, Bhalla K, Bhandari B, Bikbov B, Bin Abdulhak A, Birbeck G, Black JA, Blencowe H, Blore JD, Blyth F, Bolliger I, Bonaventure A, Boufous S, Bourne R, Boussinesq M, Braithwaite T, Brayne C, Bridgett L, Brooker S, Brooks P, Brugha TS, Bryan-Hancock C, Bucello C, Buchbinder R, Buckle G, Budke CM, Burch M, Burney P, Burstein R, Calabria B, Campbell B, Canter CE, Carabin H, Carapetis J, Carmona L, Cella C, Charlson F, Chen H, Cheng ATA, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahiya M, Dahodwala N, Damsere-Derry J, Danaei G, Davis A, De Leo D, Degenhardt L, Dellavalle R, Delossantos A, Denenberg J, Derrett S, Des Jarlais DC, Dharmaratne SD, Dherani M, Diaz-Torne C, Dolk H, Dorsey ER, Driscoll T, Duber H, Ebel B, Edmond K, Elbaz A, Ali SE, Erskine H, Erwin PJ, Espindola P, Ewoigbokhan SE, Farzadfar F, Feigin V, Felson DT, Ferrari A, Ferri CP, Fèvre EM, Finucane MM, Flaxman S, Flood L, Foreman K, Forouzanfar MH, Fowkes FG, Fransen M, Freeman MK, Gabbe BJ, Gabriel SE, Gakidou E, Ganatra HA, Garcia B, Gaspari F, Gillum RF, Gmel G, Gonzalez-Medina D, Gosselin R, Grainger R, Grant B, Groeger J, Guillemin F, Gunnell D, Gupta R, Haagsma J, Hagan H, Halasa YA, Hall W, Haring D, Haro JM, Harrison JE, Havmoeller R, Hay RJ, Higashi H, Hill C, Hoen B, Hoffman H, Hotez PJ, Hoy D, Huang JJ, Ibeanusi SE, Jacobsen KH, James SL, Jarvis D, Jasrasaria R, Jayaraman S, Johns N, Jonas JB, Karthikeyan G, Kassebaum N, Kawakami N, Keren A, Khoo JP, King CH, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Laden F, Lalloo R, Laslett LL, Lathlean T, Leasher JL, Lee YY, Leigh J, Levinson D, Lim SS, Limb E, Lin JK, Lipnick M, Lipshultz SE, Liu W, Loane M, Ohno SL, Lyons R, Mabweijano J, MacIntyre MF, Malekzadeh R, Mallinger L, Manivannan S, Marcenes W, March L, Margolis DJ, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGill N, McGrath J, Medina-Mora ME, Meltzer M, Mensah GA, Merriman TR, Meyer AC, Miglioli V, Miller M, Miller TR, Mitchell PB, Mock C, Mocumbi AO, Moffitt TE, Mokdad AA, Monasta L, Montico M, Moradi-Lakeh M, Moran A, Morawska L, Mori R, Murdoch ME, Mwaniki MK, Naidoo K, Nair MN, Naldi L, Narayan KM, Nelson PK, Nelson RG, Nevitt MC, Newton CR, Nolte S, Norman P, Norman R, O'Donnell M, O'Hanlon S, Olives C, Omer SB, Ortblad K, Osborne R, Ozgediz D, Page A, Pahari B, Pandian JD, Rivero AP, Patten SB, Pearce N, Padilla RP, Perez-Ruiz F, Perico N, Pesudovs K, Phillips D, Phillips MR, Pierce K, Pion S, Polanczyk GV, Polinder S, Pope CA, Popova S, Porrini E, Pourmalek F, Prince M, Pullan RL, Ramaiah KD, Ranganathan D, Razavi H, Regan M, Rehm JT, Rein DB, Remuzzi G, Richardson K, Rivara FP, Roberts T, Robinson C, De Leòn FR, Ronfani L, Room R, Rosenfeld LC, Rushton L, Sacco RL, Saha S, Sampson U, Sanchez-Riera L, Sanman E, Schwebel DC, Scott JG, Segui-Gomez M, Shahraz S, Shepard DS, Shin H, Shivakoti R, Singh D, Singh GM, Singh JA, Singleton J, Sleet DA, Sliwa K, Smith E, Smith JL, Stapelberg NJ, Steer A, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Syed S, Tamburlini G, Tavakkoli M, Taylor HR, Taylor JA, Taylor WJ, Thomas B, Thomson WM, Thurston GD, Tleyjeh IM, Tonelli M, Towbin JA, Truelsen T, Tsilimbaris MK, Ubeda C, Undurraga EA, van der Werf MJ, van Os J, Vavilala MS, Venketasubramanian N, Wang M, Wang W, Watt K, Weatherall DJ, Weinstock MA, Weintraub R, Weisskopf MG, Weissman MM, White RA, Whiteford H, Wiebe N, Wiersma ST, Wilkinson JD, Williams HC, Williams SR, Witt E, Wolfe F, Woolf AD, Wulf S, Yeh PH, Zaidi AK, Zheng ZJ, Zonies D, Lopez AD, AlMazroa MA, Memish ZA. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec 15;380(9859):2197–223. doi: 10.1016/S0140-6736(12)61689-4.
    1. Sedgh G, Singh S, Hussain R. Intended and unintended pregnancies worldwide in 2012 and recent trends. Stud Fam Plann. 2014 Sep;45(3):301–14. doi: 10.1111/j.1728-4465.2014.00393.x.
    1. Weinberger MB, Fry K, Boler T, Hopkins K. Estimating the contribution of a service delivery organisation to the national modern contraceptive prevalence rate: Marie Stopes International's Impact 2 model. BMC Public Health. 2013;13 Suppl 2:S5. doi: 10.1186/1471-2458-13-S2-S5.
    1. Weinberger M, Fry K, Hopkins K. Marie Stopes International. London: Marie Stopes International; 2015. [2020-01-26]. Impact 2 v3: An innovative tool for estimating the impact of reproductive health programmes-methodology paper
    1. The World Bank. [2018-02-08]. World Development Indicators: Cambodia .
    1. Rozemuller B, Thou P, Yan S. International Labour Organization. Phnom Penh, Cambodia: International Labour Organisation, Ministry of Rural Development Cambodia; 2002. [2020-01-26]. Rural Transporters: A Survey of Transport Businesses in Rural Cambodia .
    1. Potdar R, Fetters T, Phirun L. Initial loss of productive days and income among women seeking induced abortion in Cambodia. J Midwifery Womens Health. 2008;53(2):123–9. doi: 10.1016/j.jmwh.2007.06.010.
    1. Drummond MF, Sculpher MJ, Torrance GW, O'Brien BJ, Stoddart GL. Methods For The Economic Evaluation Of Health Care Programmes. Oxford, UK: Oxford University Press; 2005.
    1. Briggs AH, Claxton K, Sculpher MJ. Decision Modelling For Health Economic Evaluation. Oxford, UK: Oxford University Press; 2006.
    1. Caro JJ, Briggs AH, Siebert U, Kuntz KM, ISPOR-SMDM Modeling Good Research Practices Task Force Modeling good research practices--overview: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force--1. Value Health. 2012;15(6):796–803. doi: 10.1016/j.jval.2012.06.012.
    1. Barton GR, Briggs AH, Fenwick EA. Optimal cost-effectiveness decisions: the role of the cost-effectiveness acceptability curve (CEAC), the cost-effectiveness acceptability frontier (CEAF), and the expected value of perfection information (EVPI) Value Health. 2008;11(5):886–97. doi: 10.1111/j.1524-4733.2008.00358.x.
    1. Ochalek J, Claxton K, Lomas J. CHE Research Paper. York, UK: Centre for Health Economics, University of York; 2015. [2020-01-26]. Cost Per DALY Averted Thresholds for Low- and Middle-Income Countries: Evidence From Cross Country Data .
    1. Woods B, Revill P, Sculpher M, Claxton K. Country-Level Cost-Effectiveness Thresholds: Initial Estimates and the Need for Further Research. Value Health. 2016 Dec;19(8):929–935. doi: 10.1016/j.jval.2016.02.017.
    1. Stuart GS, Grimes DA. Social desirability bias in family planning studies: a neglected problem. Contraception. 2009 Aug;80(2):108–12. doi: 10.1016/j.contraception.2009.02.009.
    1. Guerriero C, Cairns J, Roberts I, Rodgers A, Whittaker R, Free C. The cost-effectiveness of smoking cessation support delivered by mobile phone text messaging: Txt2stop. Eur J Health Econ. 2013 Oct;14(5):789–97. doi: 10.1007/s10198-012-0424-5.
    1. Iribarren SJ, Cato K, Falzon L, Stone PW. What is the economic evidence for mHealth? A systematic review of economic evaluations of mHealth solutions. PLoS One. 2017;12(2):e0170581. doi: 10.1371/journal.pone.0170581.
    1. Mangone ER, Agarwal S, L'Engle K, Lasway C, Zan T, van Beijma H, Orkis J, Karam R. Sustainable Cost Models for mHealth at Scale: Modeling Program Data from m4RH Tanzania. PLoS One. 2016;11(1):e0148011. doi: 10.1371/journal.pone.0148011.
    1. Zakiyah N, van Asselt AD, Roijmans F, Postma MJ. Economic Evaluation of Family Planning Interventions in Low and Middle Income Countries; A Systematic Review. PLoS One. 2016;11(12):e0168447. doi: 10.1371/journal.pone.0168447.
    1. High-Impact Practices in Family Planning. Washington, DC: USAID; 2018. [2020-01-26]. Digital Health for Social and Behavior Change: New technologies, new ways to reach people
    1. Korachais C, Macouillard E, Meessen B. How User Fees Influence Contraception in Low and Middle Income Countries: A Systematic Review. Stud Fam Plann. 2016 Dec 17;47(4):341–356. doi: 10.1111/sifp.12005.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する