Costs and cost-effectiveness analyses of mCARE strategies for promoting care seeking of maternal and newborn health services in rural Bangladesh

Autoři: Youngji Jo aff001;  Amnesty E. LeFevre aff001;  Katherine Healy aff001;  Neelu Singh aff001;  Kelsey Alland aff001;  Sucheta Mehra aff001;  Hasmot Ali aff002;  Saijuddin Shaikh aff002;  Rezawanul Haque aff002;  Parul Christian aff001;  Alain B. Labrique aff001
Působiště autorů: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America aff001;  JiVitA Program, Johns Hopkins University, Gaibandha, Bangladesh aff002
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article



We examined the incremental cost-effectiveness between two mHealth programs, implemented from 2011 to 2015 in rural Bangladesh: (1) Comprehensive mCARE package as an intervention group and (2) Basic mCARE package as a control group.


Both programs included a core package of census enumeration and pregnancy surveillance provided by an established cadre of digitally enabled community health workers (CHWs). In the comprehensive mCARE package, short message service (SMS) and home visit reminders were additionally sent to pregnant women (n = 610) and CHWs (n = 70) to promote the pregnant women’s care-seeking of essential maternal and newborn care services. Economic costs were assessed from a program perspective inclusive of development, start-up, and implementation phases. Effects were calculated as disability adjusted life years (DALYs) and the number of newborn deaths averted. For comparative purposes, we normalized our evaluation to estimate total costs and total newborn deaths averted per 1 million people in a community for both groups. Uncertainty was assessed using probabilistic sensitivity analyses with Monte Carlo simulation.


The addition of SMS and home visit reminders based on a mobile phone-facilitated pregnancy surveillance system was highly cost effective at a cost per DALY averted of $31 (95% uncertainty range: $19–81). The comprehensive mCARE program had at least 88% probability of being highly cost-effective as compared to the basic mCARE program based on the threshold of Bangladesh’s GDP per capita.


mHealth strategies such as SMS and home visit reminders on a well-established pregnancy surveillance system may improve service utilization and program cost-effectiveness in low-resource settings.

Klíčová slova:

Antenatal care – Bangladesh – Cell phones – Census – Cost-effectiveness analysis – Neonatal care – Pregnancy – Software tools


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2019 Číslo 10
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