Scale Matters: A Cost-Outcome Analysis of an m-Health Intervention in Malawi.
BACKGROUND
The primary objectives of this study are to determine cost per user and cost per contact with users of a mobile health (m-health) intervention. The secondary objectives are to map costs to changes in maternal, newborn, and child health (MNCH) and to estimate costs of alternate implementation and usage scenarios.


METHODS
A base cost model, constructed from recurrent costs and selected capital costs, was used to estimate average cost per user and per contact of an m-health intervention. This model was mapped to statistically significant changes in MNCH intermediate outcomes to determine the cost of improvements in MNCH indicators. Sensitivity analyses were conducted to estimate costs in alternate scenarios.


RESULTS
The m-health intervention cost $29.33 per user and $4.33 per successful contact. The average cost for each user experiencing a change in an MNCH indicator ranged from $67 to $355. The sensitivity analyses showed that cost per user could be reduced by 48% if the service were to operate at full capacity.


CONCLUSIONS
We believe that the intervention, operating at scale, has potential to be a cost-effective method for improving maternal and child health indicators.
1 Health Systems Group, VillageReach , Seattle, Washington.
Erin
E
Larsen-Cooper
1 Health Systems Group, VillageReach , Seattle, Washington.|2 Department of Health Services, University of Washington , Seattle, Washington.
Emily
E
Bancroft
1 Health Systems Group, VillageReach , Seattle, Washington.|3 Department of Epidemiology, University of Washington , Seattle, Washington.
Sharanya
S
Rajagopal
4 Concern Worldwide Malawi Programme , Lilongwe, Malawi .
Maggie
M
O'Toole
5 Independent Consultant , Bethesda, Maryland.
Ann
A
Levin
D000067576:Child Health; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000191:economics; D015277:Hotlines; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008295:Malawi; D000068097:Maternal Health; D000068101:Maternal-Child Health Services / Q000191:economics* / Q000458:organization & administration; D011247:Pregnancy; D017216:Telemedicine / Q000191:economics* / Q000458:organization & administration; D060145:Text Messaging; D014195:Travel / Q000191:economics
child health; cost-outcome; economic evaluation; information and communications technology; maternal health; mobile health