What does it cost to expand two-way texting for post-operative follow-up? A cost analysis in routine voluntary medical male circumcision settings in South Africa.

Molly Unsworth, Isabella Fabens, Geoffrey Setswe, Khumbulani Moyo, Jacqueline Pienaar, Calsile Makhele, Motshana Phohole, Nelson Igaba, Sizwe Hlongwane, Maria Sardini, Tracy Dong, Monisha Sharma, Hannock Tweya, Felex Ndebele, Marrianne Holec, Caryl Feldacker
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Abstract

Up to 98% of adult voluntary medical male circumcision (VMMC) clients heal without adverse events (AEs) in South Africa and in the sub-Saharan Africa (SSA) region, yet all clients in South Africa (SA) are still required to attend in-person reviews, creating added work for providers and barriers for clients. A randomized controlled trial (RCT) using our fee-free, open-source, two-way texting (2wT) approach showed that males could independently monitor their healing with support from VMMC nurse-led telehealth and that 2wT was more cost-effective than routine visits for quality post-operative monitoring. The objectives of this costing activity were to assess the additive cost of 2wT vs. SoC during a stepped wedge design (SWD) expansion trial; costing an augmentation of 2wT with dedicated personnel during peak VMMC periods; and estimate the cost savings of 2wT from the payer perspective if scaled in routine VMMC settings. Data was collected from routine financial reports and complemented by previous RCT time-motion estimates. We conducted activity-based costing of SWD and peak season periods; sensitivity analysis estimated 2wT costs at scale. We included data from 6,842 males, with 2,586 (38%) opting for 2wT. 2wT participants attended an average of zero visits; SoC males had an average of 2 visits. Under 2wT, quality care markers improved and AE ascertainment increased while loss to follow-up (LTFU) decreased. Given a VMMC population of 10,000 adults, scenario analysis suggests that: 1) 2wT becomes cost neutral with 45% 2wT enrollment; 2) 2wT saves $0.29/client with 60% 2wT enrollment; and 3) 2wT saves $0.46/client with 80% 2wT enrollment. When implemented at scale, 2wT appears to significantly reduce costs to the healthcare system while improving the quality of post-operative care and requiring no additional client costs. 2wT should be expanded for eligible males across VMMC and other post-operative contexts in South Africa.

扩大术后随访的双向短信需要多少钱?南非常规自愿医疗男性包皮环切的成本分析。
在南非和撒哈拉以南非洲(SSA)地区,高达98%的成年自愿医疗男性包皮环切术(VMMC)患者在没有不良事件(ae)的情况下痊愈,但南非(SA)的所有患者仍然需要参加现场审查,这给提供者带来了额外的工作,也给客户带来了障碍。一项采用免费、开源、双向短信(2wT)方法的随机对照试验(RCT)显示,在VMMC护士主导的远程医疗的支持下,男性可以独立监测他们的愈合情况,并且2wT比常规随访更具有成本效益,可以进行高质量的术后监测。本次成本评估活动的目的是在阶梯楔形设计(SWD)扩展试验期间评估2wT与SoC的附加成本;在VMMC高峰期,配备专门人员的成本增加了2wT;并从付款人的角度估计如果在常规VMMC设置中扩展2wT的成本节约。数据从常规财务报告中收集,并辅以以前的RCT时间运动估计。我们对社会福利署和旺季进行了作业成本核算;敏感性分析估计了2wT的规模成本。我们纳入了6842名男性的数据,其中2586名(38%)选择2wT。2wT参与者平均零次访问;SoC男性平均有2次访问。在2wT下,质量护理指标改善,AE确定增加,而随访损失(LTFU)减少。假设VMMC人口为10,000名成年人,情景分析表明:1)2wT在45%的2wT入组率下达到成本中性;2) 2wT注册率为60%,每位客户节省0.29美元;3) 2wT注册率为80%,每位客户节省0.46美元。当大规模实施时,2wT似乎显著降低了医疗保健系统的成本,同时提高了术后护理的质量,并且不需要额外的客户成本。2wT应在南非的VMMC和其他术后环境中扩大适用于符合条件的男性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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