Mobile phone adherence support for antiretroviral therapy: What would it cost the National AIDS Control Program in India? Rodrigues R, Shet A, Swaroop.

Mobile phone adherence support for antiretroviral therapy: What would it cost the

National AIDS Control Program in India?

Rodrigues R, Shet A, Swaroop N, Shastri S, Bogg L, De Costa A

St. John’s National Academy of Health Sciences, National AIDS Control Organisation

Bangalore, India Karolinska Institutet, Stockholm, Sweden

WEAE0303

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HIV prevalence : 0.3%* People with HIV: 2.5 millionHIV patients on treatment: 0.4million#

Study Setting

INDIA

*UNAIDS. Global Report 2010, #NACO March 2012

BangalorePrivate teaching hospital withGovernment ART center

MysoreGovernment teaching hospital and ART center

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Introduction

Good adherence defers failure to 1st line ART optimizes healthcare outcomes - reduces healthcare costs*

Interventions involving mobile telephones – found suitable for improving adherence#,@ – could reduce healthcare costs

*World Health Organisation (2003) Adherence to Long-term Therapies#Weltel Kenya, @Prompting medication reminders- Cameroon

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Objective

To assess the cost of weekly mobile phone reminders*for adherence support in the context of the

Indian National AIDS control Program

* HIVIND trial

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The Mobile Phone Intervention

Patientwith

mobile phoneOn Ry

+

Interactive Voice

ResponseCall (IVR)

Pictorial SMS

Weekly

Weekly

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Assumptions

This costing was from the program perspective:

Hence,

Expenses in relation to the trial implementation were not considered

The technical providers of the intervention -considered most economical

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Costing Methodology

The sequential procedure for costing was used:1. Identifying the resource used in natural units

(minutes/any other units) 2. Measuring resource use 3. Pricing the resource

Sensitivity analysis for intervention scale up: 1. Varying the number of patients (IVR+SMS)2. Varying the components of intervention

ie; (i) SMS alone (ii) IVR alone and

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Costs One time costs: Costs incurred for Intervention

development

Recurrent Costs: Fixed costs: Annual maintenance fee for

equipment, staff cost, overheads Variable cost: IVR and SMS cost/ patient,

staff cost- intervention related

Total Costs: One time cost + Fixed costs + n (variable costs)

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Results

One-time costsCosts (USD)

Annualised cost (USD)

Development of the intervention 452.99/5yrs 90.60Development of the web interface 201.33/5yrs 40.27Equipment costs [1 computer (10% time) and 1 mobile phone) 664.38/5yrs 13.29Total one time costs 144.15

One time costs

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Fixed costs Cost (USD)

Annualised cost (USD)

Service maintenance 603.99/year 603.99

Equipment maintenance 28.19/3years 9.40

Program manager (10% of annual time, 503.32USD/mth salary) 603.99

Overheads 201.33/year 114.40

Data manager (15min/week, 140.93USD/mth salary) 10.63

Total fixed cost 1342.40

Fixed Cost

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Variable CostsCosts (USD)

Annual Cost/patient (USD)

IVR cost 0.030/IVR 1.57SMS cost 0.004/SMS 0.21Counselor (20min/patient/year, 24.16USD/mth salary) 0.11Total variable cost 1.89Total costs Annual Cost (USD)

One-time cost + Fixed costs + n (variable costs) 4518.07Total Cost/patient (number of patients 1600) 2.82

Variable and Total costs/ patient

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0

0.5

1

1.5

2

2.5

3

3.5

1600 50000 100000 426000 800000

Number of patients

Co

st/

pati

en

t (U

SD

)

Variable costs Total Costs

Sensitivity analysis: Total and variable costs intervention scale up

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Sensitivity analysis:Cost for intervention scale-up (IVR+SMS)

CostsUSD 60000 426000 800000

One time cost 715.52 6011.27 6011.27

Fixed cost 59065.40 420169.80 420169.80Variable cost/patient 1.26 0.67 0.67

Total cost 135318.45 712282.7 963461.06Total cost/patient 2.26 1.67 1.20

Patients

Total cost of Intervention scale-up for 0.8 million patients: 0.16% of the 5year NACP VI budget

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Sensitivity analysis: Cost for IVR / SMS Scale-upRegion Karnataka India IndiaLanguages 5 32 32

ART centers 44 313 313

Patients 60000 426000 800000

Intervention IVR SMS IVR SMS IVR SMS

Onetime+fixed cost (USD)

59781 59690 420169 424370 420170 424369

Variable cost/pt 1.15 0.22 0.63 0.15 0.63 0.15

Total cost (USD)* 129078 72828 688549 488951 924170 545649

Totalcost/pt (USD)

2.15 1.21 1.62 1.15 1.16 0.68

*Total cost = One time + fixed cost + n (variable cost)

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Conclusion

The Indian National AIDS Control Program would incur an overall cost of 0.16% of its current 5year budget for mobile phone adherence support of ART

Given the current implementation costs, the intervention has the potential to improve health system effectiveness and enable the achievement of program goals in the Indian context

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The authors declare that they have no competing interests

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Thank you!!!