Background: Variety of strategies are being tried to improve the performance of accredited social health activists (ASHA), village level health workers, in order to augment the demand for health services. One such strategy is introduction of m-health interventions. The objective of the present paper is to comprehensively assess the incremental cost per disability adjusted life year averted as a result of the m-health intervention (ReMiND project) as compared to routine program without the m-health intervention.
Methods: A decision tree was parameterized on MS-Excel spreadsheet to estimate the incremental cost effectiveness of implementing ReMiND project, from both health system and societal perspective. A time horizon of 10 years starting from base year of 2011 was considered appropriate to cover all costs and effects comprehensively. All costs, including those during start-up and implementation phase, besides other costs on the health system or households was estimated. Consequences were valued in terms of maternal and infant illnesses and deaths averted, and disability adjusted life years averted. Sensitivity analysis was undertaken to account for uncertainties.
Results: Cumulatively, from 2011 to 2020, implementation of ReMiND intervention in UP would result in a reduction of 16, 918 maternal and 119,646 neonatal deaths during the 10-year period. This implies a reduction of 16.4% maternal and 5.2% neonatal deaths. Overall, ReMiND incurs an incremental cost of INR 6078 (USD 96) per DALY averted and INR 176,752 (USD 2792) per death averted.
Conclusion: Overall, the findings of our study suggest strongly that the m-health intervention as part of the ReMiND project is very cost effective from Indian health system’s viewpoint and should be considered for replication elsewhere in other states.
