title: Economic Evaluation of Text-Messaging and Smartphone-Based Interventions to Improve Medication Adherence in Adolescents with Chronic Health Conditions: A Systematic Review.
abstract: BACKGROUND
  The rate of chronic health conditions (CHCs) in children and adolescents has doubled in the past 20 years, with increased health care costs. Technology-based interventions have demonstrated efficacy to improving medication adherence. However, data to support the cost effectiveness of these interventions are lacking.
  
  
  OBJECTIVE
  The objective of this study is to conduct an economic evaluation of text-messaging and smartphone-based interventions that focus on improving medication adherence in adolescents with CHCs.
  
  
  METHODS
  Searches included PubMed MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, and Inspec. Eligibility criteria included age (12-24 years old), original articles, outcomes for medication adherence, and economic outcomes.
  
  
  RESULTS
  Our search identified 1118 unique articles that were independently screened. A total of 156 articles met inclusion criteria and were then examined independently with full-text review. A total of 15 articles met most criteria but lacked economic outcomes such as cost effectiveness or cost-utility data. No articles met all predefined criteria to be included for final review. Only 4 articles (text messaging [n=3], electronic directly observed therapy [n=1]) described interventions with possible future cost-saving but no formal economic evaluation.
  
  
  CONCLUSIONS
  The evidence to support the cost effectiveness of text-messaging and smartphone-based interventions in improving medication adherence in adolescents with CHCs is insufficient. This lack of research highlights the need for comprehensive economic evaluation of such interventions to better understand their role in cost-savings while improving medication adherence and health outcomes. Economic evaluation of technology-based interventions can contribute to more evidence-based assessment of the scalability, sustainability, and benefits of broader investment of such technology tools in adolescents with CHCs.
authors: Ann and Robert H Lurie Children's Hospital of Chicago, Department of Pediatrics, Division of Hematology, Oncology, and Stem Cell Transplant, Northwestern University Feinberg School of Medicine, Chicago, IL, United States. sbadawy@luriechildrens.org.
authors: Sherif M
authors: http://orcid.org/0000-0002-4739-265X
authors: SM
authors: Badawy
authors: Lisa M
authors: http://orcid.org/0000-0001-8294-7801
authors: LM
authors: Kuhns
keywords: adolescent; chronic disease; cost-benefit analysis; medication adherence; smartphone; text messaging