Economic Evaluation of a Multicomponent mHealth Intervention for Stroke Management in Rural China: Cluster-Randomized...

Area of Science:

• Health Services Research
• Implementation Science
• Digital Health

Background:

• Suboptimal stroke management in rural China necessitates innovative solutions.
• Mobile health-enabled strategies can empower primary care providers.
• The SINEMA model demonstrated effectiveness in reducing blood pressure and mortality in rural stroke patients.

Purpose of the Study:

• To evaluate the cost-effectiveness of the SINEMA intervention.
• To assess the budget impact of SINEMA for nationwide scalability.
• To analyze the intervention's cost-effectiveness during trial and post-trial periods.

Main Methods:

• A cluster-randomized implementation trial involving 50 villages and 1299 stroke patients.
• Estimation of incremental cost-effectiveness ratios (ICER) for blood pressure reduction and quality-adjusted life years (QALYs).
• Probabilistic and deterministic sensitivity analyses were performed.
• Budget impact analysis from a public payer perspective for national scale-up.

Main Results:

• The ICER per 1 mmHg systolic blood pressure reduction was $8.4.
• The ICER per QALY gained was $837.9 within-trial and $727.9 post-trial, indicating high cost-effectiveness.
• First-year budget impact ranged from $115.6 million to $197.7 million, decreasing to $46.6 million to $78.7 million by year 5.

Conclusions:

• The SINEMA intervention is cost-effective during the trial and a 6-year sustainability observation period.
• Health system-integrated, mobile health strategies show promise for managing stroke and other chronic diseases in resource-limited settings.
• SINEMA offers a scalable model for improving rural healthcare delivery.