IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0265033.html

A cost analysis of implementing mobile health facilitated tuberculosis contact investigation in a low-income setting

Author

Listed:
  • Patricia Turimumahoro
  • Austin Tucker
  • Amanda J Gupta
  • Radhika P Tampi
  • Diana Babirye
  • Emmanuel Ochom
  • Joseph M Ggita
  • Irene Ayakaka
  • Hojoon Sohn
  • Achilles Katamba
  • David Dowdy
  • J Lucian Davis

Abstract

Introduction: Mobile health (mHealth) applications may improve timely access to health services and improve patient-provider communication, but the upfront costs of implementation may be prohibitive, especially in resource-limited settings. Methods: We measured the costs of developing and implementing an mHealth-facilitated, home-based strategy for tuberculosis (TB) contact investigation in Kampala, Uganda, between February 2014 and July 2017. We compared routine implementation involving community health workers (CHWs) screening and referring household contacts to clinics for TB evaluation to home-based HIV testing and sputum collection and transport with test results delivered by automated short messaging services (SMS). We carried out key informant interviews with CHWs and asked them to complete time-and-motion surveys. We estimated program costs from the perspective of the Ugandan health system, using top-down and bottom-up (components-based) approaches. We estimated total costs per contact investigated and per TB-positive contact identified in 2018 US dollars, one and five years after program implementation. Results: The total top-down cost was $472,327, including $358,504 (76%) for program development and $108,584 (24%) for program implementation. This corresponded to $320-$348 per household contact investigated and $8,873-$9,652 per contact diagnosed with active TB over a 5-year period. CHW time was spent primarily evaluating household contacts who returned to the clinic for evaluation (median 30 minutes per contact investigated, interquartile range [IQR]: 30–70), collecting sputum samples (median 29 minutes, IQR: 25–30) and offering HIV testing services (median 28 minutes, IQR: 17–43). Cost estimates were sensitive to infrastructural capacity needs, program reach, and the epidemiological yield of contact investigation. Conclusion: Over 75% of all costs of the mHealth-facilitated TB contact investigation strategy were dedicated to establishing mHealth infrastructure and capacity. Implementing the mHealth strategy at scale and maintaining it over a longer time horizon could help decrease development costs as a proportion of total costs.

Suggested Citation

  • Patricia Turimumahoro & Austin Tucker & Amanda J Gupta & Radhika P Tampi & Diana Babirye & Emmanuel Ochom & Joseph M Ggita & Irene Ayakaka & Hojoon Sohn & Achilles Katamba & David Dowdy & J Lucian Dav, 2022. "A cost analysis of implementing mobile health facilitated tuberculosis contact investigation in a low-income setting," PLOS ONE, Public Library of Science, vol. 17(4), pages 1-13, April.
    • Handle: RePEc:plo:pone00:0265033
    DOI: 10.1371/journal.pone.0265033
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0265033
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0265033&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0265033?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Michael K. Chapko & Chuan‐Fen Liu & Mark Perkins & Yu‐Fang Li & John C. Fortney & Matthew L. Maciejewski, 2009. "Equivalence of two healthcare costing methods: bottom‐up and top‐down," Health Economics, John Wiley & Sons, Ltd., vol. 18(10), pages 1188-1201, October.
    2. repec:wbk:wbpubs:21634 is not listed on IDEAS
    3. Sarah J Iribarren & Kenrick Cato & Louise Falzon & Patricia W Stone, 2017. "What is the economic evidence for mHealth? A systematic review of economic evaluations of mHealth solutions," PLOS ONE, Public Library of Science, vol. 12(2), pages 1-20, February.
    4. Youngji Jo & Farangiz Mirzoeva & Monyrath Chry & Zhi Zhen Qin & Andrew Codlin & Oktam Bobokhojaev & Jacob Creswell & Hojoon Sohn, 2020. "Standardized framework for evaluating costs of active case-finding programs: An analysis of two programs in Cambodia and Tajikistan," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-12, January.
    5. repec:wbk:wbpubs:18237 is not listed on IDEAS
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Bugge, Christoffer & Sæther, Erik Magnus & Brustugun, Odd Terje & Kristiansen, Ivar Sønbø, 2021. "Societal cost of cancer in Norway –Results of taking a broader cost perspective," Health Policy, Elsevier, vol. 125(8), pages 1100-1107.
    2. Shankar Prinja & Akashdeep Singh Chauhan & Pankaj Bahuguna & Sakhtivel Selvaraj & V. R. Muraleedharan & Thiagarajan Sundararaman, 2020. "Cost of Delivering Secondary Healthcare Through the Public Sector in India," PharmacoEconomics - Open, Springer, vol. 4(2), pages 249-261, June.
    3. Pal, Sumantra, 2022. "Mobile health interventions: A policymakers’ note on the World’s largest Nutrition Surveillance in India," EconStor Preprints 264272, ZBW - Leibniz Information Centre for Economics.
    4. Lucy Cunnama & Edina Sinanovic & Lebogang Ramma & Nicola Foster & Leigh Berrie & Wendy Stevens & Sebaka Molapo & Puleng Marokane & Kerrigan McCarthy & Gavin Churchyard & Anna Vassall, 2016. "Using Top‐down and Bottom‐up Costing Approaches in LMICs: The Case for Using Both to Assess the Incremental Costs of New Technologies at Scale," Health Economics, John Wiley & Sons, Ltd., vol. 25(S1), pages 53-66, February.
    5. Secinaro, Silvana & Lanzalonga, Federico & Oppioli, Michele & de Nuccio, Elbano, 2025. "The effects of disruptive technologies on accountability in fintech industry: Using bibliometric analysis to develop a research agenda," Research in International Business and Finance, Elsevier, vol. 76(C).
    6. Yeonsoo Jang & Sang Hoon Ahn & Kyunghwa Lee & Oh Young Kwon & Jeong Hyun Kim, 2021. "Development and Pilot Testing of a Smartphone-Based Self-Care Program for Patients with Chronic Hepatitis B," IJERPH, MDPI, vol. 18(21), pages 1-13, October.
    7. Youngji Jo & Amnesty E LeFevre & Katherine Healy & Neelu Singh & Kelsey Alland & Sucheta Mehra & Hasmot Ali & Saijuddin Shaikh & Rezawanul Haque & Parul Christian & Alain B Labrique, 2019. "Costs and cost-effectiveness analyses of mCARE strategies for promoting care seeking of maternal and newborn health services in rural Bangladesh," PLOS ONE, Public Library of Science, vol. 14(10), pages 1-13, October.
    8. Vogl, Matthias, 2013. "Improving patient-level costing in the English and the German ‘DRG’ system," Health Policy, Elsevier, vol. 109(3), pages 290-300.
    9. Akashdeep Singh Chauhan & Shankar Prinja & Sushmita Ghoshal & Roshan Verma & Arun S Oinam, 2018. "Cost of treatment for head and neck cancer in India," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-13, January.
    10. Secinaro, Silvana & Brescia, Valerio & Lanzalonga, Federico & Santoro, Gabriele, 2022. "Smart city reporting: A bibliometric and structured literature review analysis to identify technological opportunities and challenges for sustainable development," Journal of Business Research, Elsevier, vol. 149(C), pages 296-313.
    11. Cohen, Deborah & Manuel, Douglas G. & Tugwell, Peter & Sanmartin, Claudia & Ramsay, Tim, 2014. "Direct healthcare costs of acute myocardial infarction in Canada’s elderly across the continuum of care," The Journal of the Economics of Ageing, Elsevier, vol. 3(C), pages 44-49.
    12. Kathleen Carey & Theodore Stefos, 2011. "Measuring the cost of hospital adverse patient safety events," Health Economics, John Wiley & Sons, Ltd., vol. 20(12), pages 1417-1430, December.
    13. Helena Biancuzzi & Francesca Dal Mas & Chiara Bidoli & Veronica Pegoraro & Maristella Zantedeschi & Pietro Antonio Negro & Stefano Campostrini & Lorenzo Cobianchi, 2023. "Economic and Performance Evaluation of E-Health before and after the Pandemic Era: A Literature Review and Future Perspectives," IJERPH, MDPI, vol. 20(5), pages 1-18, February.
    14. Indrani Gupta & Mayur Trivedi & Vishal Jani & Kanksha Barman & Avantika Ranjan & Manas Sharma, 2021. "Costing Of Health And Wellness Centre A Case Study Of Gujarat," IEG Working Papers 415, Institute of Economic Growth.
    15. Abdelbaste Hrifach & Coralie Brault & Sandrine Couray-Targe & Lionel Badet & Pascale Guerre & Christell Ganne & Hassan Serrier & Vanessa Labeye & Pierre Farge & Cyrille Colin, 2016. "Mixed method versus full top-down microcosting for organ recovery cost assessment in a French hospital group," Health Economics Review, Springer, vol. 6(1), pages 1-7, December.
    16. Liliana Castillo-Rodríguez & Diana Malo-Sánchez & Diana Díaz-Jiménez & Ingrid García-Velásquez & Paola Pulido & Carlos Castañeda-Orjuela, 2022. "Economic costs of severe seasonal influenza in Colombia, 2017–2019: A multi-center analysis," PLOS ONE, Public Library of Science, vol. 17(6), pages 1-13, June.
    17. Alex Armand & Mattia Fracchia & Pedro C. Vicente, 2024. "Let's call! Using the phone to increase vaccine acceptance," Health Economics, John Wiley & Sons, Ltd., vol. 33(1), pages 82-106, January.
    18. Šárka Papadaki & Boris Popesko, 2016. "Cost Analysis of Selected Patient Categories Within A Dermatology Department Using an ABC Approach," Global Journal of Health Science, Canadian Center of Science and Education, vol. 8(6), pages 234-234, June.
    19. Nkiruka D Eze & Céu Mateus & Tiago Cravo Oliveira Hashiguchi, 2020. "Telemedicine in the OECD: An umbrella review of clinical and cost-effectiveness, patient experience and implementation," PLOS ONE, Public Library of Science, vol. 15(8), pages 1-24, August.
    20. Calandra, Davide & Lanzalonga, Federico & Secinaro, Silvana & Storti, Cláudia Costa, 2025. "From traditional to digital: Unravelling performance measurement systems and accounting methods in drug treatment through a systematic review and content analysis," The British Accounting Review, Elsevier, vol. 57(6).

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0265033. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.