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首页> 外文期刊>JMIR mHealth and uHealth >Forecasting the Value for Money of Mobile Maternal Health Information Messages on Improving Utilization of Maternal and Child Health Services in Gauteng, South Africa: Cost-Effectiveness Analysis
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Forecasting the Value for Money of Mobile Maternal Health Information Messages on Improving Utilization of Maternal and Child Health Services in Gauteng, South Africa: Cost-Effectiveness Analysis

机译：预测移动式孕产妇保健信息消息的货币价值，以提高南非豪登省妇幼保健服务的利用：成本-效果分析

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Background Limited evidence exists on the value for money of mHealth information programs in low resource settings. Objective This study sought to model the incremental cost-effectiveness of gradually scaling up text messaging services to pregnant women throughout Gauteng province, South Africa from 2012 to 2017. Methods Data collection occurred as part of a retrospective study in 6 health centers in Gauteng province. Stage-based short message service (SMS) text messages on maternal health were sent to pregnant women twice per week during pregnancy and continued until the infant’s first birthday. Program costs, incremental costs to users, and the health system costs for these women were measured along with changes in the utilization of antenatal care visits and childhood immunizations and compared with those from a control group of pregnant women who received no SMS text messages. Incremental changes in utilization were entered into the Lives Saved Tool and used to forecast lives saved and disability adjusted life years (DALYs) averted by scaling up program activities over 5 years to reach 60% of pregnant women across Gauteng province. Uncertainty was characterized using one-way and probabilistic uncertainty analyses. Results Five-year program costs were estimated to be US $1.2 million, 17% of which were incurred by costs on program development and 31% on SMS text message delivery costs. Costs to users were US $1.66 to attend clinic-based services, nearly 90% of which was attributed to wages lost. Costs to the health system included provider time costs to register users (US $0.08) and to provide antenatal care (US $4.36) and postnatal care (US $3.08) services. Incremental costs per DALY averted from a societal perspective ranged from US $1985 in the first year of implementation to US $200 in the 5th year. At a willingness-to-pay threshold of US $2000, the project had a 40% probability of being cost-effective in year 1 versus 100% in all years thereafter. Conclusions Study findings suggest that delivering SMS text messages on maternal health information to pregnant and postpartum women may be a cost-effective strategy for bolstering antenatal care and childhood immunizations, even at very small margins of coverage increases. Primary data obtained prospectively as part of more rigorous study designs are needed to validate modeled results.
机译：背景技术在资源匮乏的情况下，关于mHealth信息程序的物有所值的证据有限。目的本研究旨在模拟从2012年至2017年在南非豪登省逐步扩大向孕妇提供短信服务的增量成本效益。方法数据收集是在豪登省6个卫生中心进行的回顾性研究的一部分。在怀孕期间，每周两次向孕妇发送基于阶段的短信服务（SMS）的孕产妇健康短信，并持续到婴儿的第一个生日。测量了这些妇女的计划成本，使用者的增量成本以及卫生系统成本，以及产前保健就诊和儿童免疫接种使用率的变化，并与未收到短信的孕妇对照组进行了比较。利用率的增量变化被输入到“挽救生命的工具”中，并用于预测挽救的生命和通过调整计划活动超过5年而避免的残疾调整生命年（DALYs），以覆盖豪登省60％的孕妇。使用单向和概率不确定性分析来表征不确定性。结果五年方案费用估计为120万美元，其中17％由方案开发费用和31％由SMS短信交付费用产生。用户参加基于诊所的服务的成本为1.66美元，其中近90％归因于工资损失。卫生系统的费用包括提供者注册用户（0.08美元），提供产前护理（4.36美元）和产后护理（3.08美元）的时间成本。从社会角度看，每个DALY的增量成本从实施第一年的1985美元到第五年的200美元不等。在支付意愿为2000美元的门槛下，该项目在第1年具有成本效益的可能性为40％，而此后所有年份为100％。结论结论研究结果表明，即使在覆盖率提高很小的情况下，向孕妇和产后妇女提供有关孕产妇健康信息的SMS短信可能是加强产前护理和儿童免疫接种的一种经济有效的策略。需要前瞻性地获得作为更严格的研究设计一部分的原始数据来验证建模结果。

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