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A cost analysis of implementing mobile health facilitated tuberculosis contact investigation in a low-income setting

Author

Listed:
  • Patricia Turimumahoro
  • Austin Tucker
  • Amanda J Gupta
  • Radhika P Tampi
  • Diana Babirye
  • Emmanuel Ochom
  • Joseph M Ggita
  • Irene Ayakaka
  • Hojoon Sohn
  • Achilles Katamba
  • David Dowdy
  • J Lucian Davis
Abstract
Introduction: Mobile health (mHealth) applications may improve timely access to health services and improve patient-provider communication, but the upfront costs of implementation may be prohibitive, especially in resource-limited settings. Methods: We measured the costs of developing and implementing an mHealth-facilitated, home-based strategy for tuberculosis (TB) contact investigation in Kampala, Uganda, between February 2014 and July 2017. We compared routine implementation involving community health workers (CHWs) screening and referring household contacts to clinics for TB evaluation to home-based HIV testing and sputum collection and transport with test results delivered by automated short messaging services (SMS). We carried out key informant interviews with CHWs and asked them to complete time-and-motion surveys. We estimated program costs from the perspective of the Ugandan health system, using top-down and bottom-up (components-based) approaches. We estimated total costs per contact investigated and per TB-positive contact identified in 2018 US dollars, one and five years after program implementation. Results: The total top-down cost was $472,327, including $358,504 (76%) for program development and $108,584 (24%) for program implementation. This corresponded to $320-$348 per household contact investigated and $8,873-$9,652 per contact diagnosed with active TB over a 5-year period. CHW time was spent primarily evaluating household contacts who returned to the clinic for evaluation (median 30 minutes per contact investigated, interquartile range [IQR]: 30–70), collecting sputum samples (median 29 minutes, IQR: 25–30) and offering HIV testing services (median 28 minutes, IQR: 17–43). Cost estimates were sensitive to infrastructural capacity needs, program reach, and the epidemiological yield of contact investigation. Conclusion: Over 75% of all costs of the mHealth-facilitated TB contact investigation strategy were dedicated to establishing mHealth infrastructure and capacity. Implementing the mHealth strategy at scale and maintaining it over a longer time horizon could help decrease development costs as a proportion of total costs.

Suggested Citation

  • Patricia Turimumahoro & Austin Tucker & Amanda J Gupta & Radhika P Tampi & Diana Babirye & Emmanuel Ochom & Joseph M Ggita & Irene Ayakaka & Hojoon Sohn & Achilles Katamba & David Dowdy & J Lucian Dav, 2022. "A cost analysis of implementing mobile health facilitated tuberculosis contact investigation in a low-income setting," PLOS ONE, Public Library of Science, vol. 17(4), pages 1-13, April.
    • Handle: RePEc:plo:pone00:0265033
    DOI: 10.1371/journal.pone.0265033
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    References listed on IDEAS

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    1. Michael K. Chapko & Chuan‐Fen Liu & Mark Perkins & Yu‐Fang Li & John C. Fortney & Matthew L. Maciejewski, 2009. "Equivalence of two healthcare costing methods: bottom‐up and top‐down," Health Economics, John Wiley & Sons, Ltd., vol. 18(10), pages 1188-1201, October.
    2. World Bank, 2015. "World Development Indicators 2015," World Bank Publications - Books, The World Bank Group, number 21634.
    3. Sarah J Iribarren & Kenrick Cato & Louise Falzon & Patricia W Stone, 2017. "What is the economic evidence for mHealth? A systematic review of economic evaluations of mHealth solutions," PLOS ONE, Public Library of Science, vol. 12(2), pages 1-20, February.
    4. Youngji Jo & Farangiz Mirzoeva & Monyrath Chry & Zhi Zhen Qin & Andrew Codlin & Oktam Bobokhojaev & Jacob Creswell & Hojoon Sohn, 2020. "Standardized framework for evaluating costs of active case-finding programs: An analysis of two programs in Cambodia and Tajikistan," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-12, January.
    5. World Bank, 2014. "World Development Indicators 2014," World Bank Publications - Books, The World Bank Group, number 18237.
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