Costing and Cost-Effectiveness of mHealth Intervention ImTeCHO in Improving Infant Mortality in Tribal Areas of Gujarat, India

Background: During 2013, an mHealth programme, Innovative Mobile Technology for Community Health Operation or ImTeCHO, was launched in predominantly tribal and rural communities of Gujarat, India. ImTeCHO was developed as job-aid for ASHAs and staff of primary health centres, to increase coverage of maternal, neonatal and child health (MNCH) care. In this paper, we assess the incremental cost per life years saved as a result of ImTeCHO intervention as compared to routine maternal and child health programmes. Methods: A two-arm, parallel, stratified cluster randomized trial with 11 clusters (PHC) randomly allocated to intervention (280 ASHAs, population: 2,34,134) and control (281 ASHAs, population: 2,42,809) arms was started in 2015 in a predominantly tribal and rural community of Gujarat. A system of surveillance in the intervention and control area assessed all live births and infant deaths in the intervention and control area. All costs, including those during start-up and implementation phase, were estimated from a programme perspective. Incremental cost-effectiveness ratios were estimated by dividing the incremental cost of the intervention with the number of deaths averted to estimate the cost per infant death averted. This was further analysed to estimate the cost per life years saved for the purpose of comparability. Sensitivity analysis was undertaken to account for parameter uncertainties. Results: Out of a total of 5,754 live births (3,014 in intervention arm, 2,740 in control arm) reported in the study area, per protocol, the implementation of ImTeCHO resulted in saving 11 infant deaths per 1,000 live births in the study area at an annual incremental cost of US$163,841. This is equivalent to US$54,360 per 1,000 live births. Overall, ImTeCHO is a cost-effective intervention from a programme perspective at an incremental cost of US$74 per life years saved or US$5,057 per death averted. In a realistic environment with district scale-up, the programme is expected to be more cost-effective. Conclusion: Overall, findings of our study suggest strongly that the mHealth intervention as part of ImTeCHO program is cost-effective and should be considered for replication elsewhere in India. Funding: Indian Council of Medical Research, John D. and Catherine T. MacArthur. Declaration of Interest: None declared. Ethical Approval: The study protocol was approved by SEWA - Rural Institutional Ethics Committee on 29th January 2016.