Economic evaluation of mobile phone text message interventions to improve adherence to HIV therapy in Kenya.
Economic evaluation of mobile phone text message interventions to improve adherence to HIV therapy in Kenya.
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DOI：
10.1097/md.0000000000006078
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发表时间：
2017-02
期刊：
影响因子：
1.6
通讯作者：
Marra CA
中科院分区：
文献类型：
--
作者：
Patel AR;Kessler J;Braithwaite RS;Nucifora KA;Thirumurthy H;Zhou Q;Lester RT;Marra CA
补充数字内容可在文本中使用移动的电话可用性的激增推动了低成本的短消息服务（SMS）依从性干预。多项系统性综述得出结论，一些基于SMS的干预措施可有效改善抗逆转录病毒治疗（ART）依从性，并假设它们可改善护理保留率。本研究的目的是评估基于SMS的依从性干预措施的成本效益，并探讨保留收益的附加值。我们评估了在肯尼亚首次启动抗逆转录病毒治疗的HIV+个体中每周SMS干预与标准护理相比的成本效益。我们使用了一个个体水平的微观模拟模型，该模型使用了来自两个SMS干预试验、一个东非HIV+队列和已发表文献的数据。我们从医疗保健的角度估计了平均质量调整生命年（QALY）和终身HIV相关成本。我们在单因素和多因素敏感性分析中探索了广泛的情景和假设。我们发现，根据WHO标准，基于SMS的依从性干预措施具有成本效益，增量成本效益比（ICER）为1，037美元/QALY。在二次分析中，潜在的保留收益提高了SMS干预的成本效益（ICER = 864美元/QALY）。 在多变量敏感性分析中，干预措施在大多数分析中仍然具有成本效益，但ICER对干预费用、有效性和ART启动时的平均队列CD 4计数高度敏感。在假定个人在检测到艾滋病毒后即开始抗逆转录病毒治疗的检测和治疗方案中，短信干预措施仍然具有成本效益。有效的SMS干预措施可能会通过以相对较低的成本改善艾滋病毒治疗结果来提高ART计划的效率，并且它们可以促进实现联合国艾滋病规划署到2020年在接受ART的人群中实现90%病毒抑制的目标。
Supplemental Digital Content is available in the text 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 cost-effectiveness of SMS-based adherence interventions and explore the added value of retention benefits. 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 SMS-intervention 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. We found that SMS-based adherence interventions were cost-effective by WHO standards, with an incremental cost-effectiveness 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. 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.