PMID- 32997710
OWN - NLM
STAT- MEDLINE
DCOM- 20201215
LR  - 20201215
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 15
IP  - 9
DP  - 2020
TI  - Cost-effectiveness analysis of two-way texting for post-operative follow-up in 
      Zimbabwe's voluntary medical male circumcision program.
PG  - e0239915
LID - 10.1371/journal.pone.0239915 [doi]
LID - e0239915
AB  - OBJECTIVE: Although adverse events (AEs) following voluntary medical male 
      circumcision (VMMC) are rare, their prompt ascertainment and management is a 
      marker of quality care. The use of two-way text messaging (2wT) for client 
      follow-up after VMMC reduces the need for clinic visits (standard of care (SoC)) 
      without compromising safety. We compared the cost-effectiveness of 2wT to SoC for 
      post-VMMC follow-up in two, high-volume, public VMMC sites in Zimbabwe. MATERIALS 
      AND METHODS: We developed a decision-analytic (decision tree) model of post-VMMC 
      client follow-up at two high-volume sites. We parameterized the model using data 
      from both a randomized controlled study of 2wT vs. SoC and from the routine VMMC 
      program. The perspective of analysis was the Zimbabwe government (payer). The 
      time horizon covered the time from VMMC to wound healing. Costs included text 
      messaging; both in-person and outreach follow-up; and AE management. Costs were 
      estimated in 2018 U.S. dollars. The outcome of analysis was AE yield relative to 
      the globally accepted safety standard of a 2% AE rate. We estimated the 
      incremental cost per percentage increase in AE ascertainment and the incremental 
      cost per additional AE identified. We conducted univariate and probabilistic 
      sensitivity analyses. RESULTS: 2wT increased the costs due to text messaging by 
      $4.42 but reduced clinic visit costs by $2.92 and outreach costs by $3.61 -a net 
      savings of $2.10. 2wT also increased AE ascertainment by 50% (92% AE yield in 2wT 
      compared to 42% AE yield in SoC). Therefore, 2wT dominated SoC in the incremental 
      analysis: 2wT was less costly and more effective. Results were generally robust 
      to univariate and probabilistic sensitivity analysis. CONCLUSIONS: 2wT is 
      cost-effective for post-VMMC follow-up in Zimbabwe. Countries in which VMMC is a 
      high-priority HIV prevention intervention should consider this mHealth 
      intervention to reduce overall cost per VMMC, increasing the likelihood of 
      current and future VMMC program sustainability.
FAU - Babigumira, Joseph B
AU  - Babigumira JB
AUID- ORCID: 0000-0003-3834-7141
AD  - Department of Global Health, University of Washington, Seattle, WA, United States 
      of America.
AD  - The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School 
      of Pharmacy, University of Washington, Seattle, WA, United States of America.
FAU - Barnhart, Scott
AU  - Barnhart S
AD  - Department of Global Health, University of Washington, Seattle, WA, United States 
      of America.
AD  - International Training and Education Center for Health (I-TECH), Seattle, WA, 
      United States of America.
AD  - Department of Medicine, University of Washington, Seattle, WA, United States of 
      America.
FAU - Mendelsohn, Joanna M
AU  - Mendelsohn JM
AD  - International Training and Education Center for Health (I-TECH), Seattle, WA, 
      United States of America.
FAU - Murenje, Vernon
AU  - Murenje V
AD  - International Training and Education Center for Health (I-TECH), Harare, 
      Zimbabwe.
FAU - Tshimanga, Mufuta
AU  - Tshimanga M
AD  - Zimbabwe Community Health Intervention Project (ZiCHIRE), Harare, Zimbabwe.
FAU - Mauhy, Christina
AU  - Mauhy C
AD  - Zimbabwe Community Health Intervention Project (ZiCHIRE), Harare, Zimbabwe.
FAU - Holeman, Isaac
AU  - Holeman I
AUID- ORCID: 0000-0002-9072-4162
AD  - Medic Mobile, Nairobi, Kenya.
FAU - Xaba, Sinokuthemba
AU  - Xaba S
AD  - Ministry of Health and Child Care, Harare, Zimbabwe.
FAU - Holec, Marrianne M
AU  - Holec MM
AD  - International Training and Education Center for Health (I-TECH), Seattle, WA, 
      United States of America.
FAU - Makunike-Chikwinya, Batsirai
AU  - Makunike-Chikwinya B
AD  - International Training and Education Center for Health (I-TECH), Harare, 
      Zimbabwe.
FAU - Feldacker, Caryl
AU  - Feldacker C
AUID- ORCID: 0000-0002-8152-6754
AD  - Department of Global Health, University of Washington, Seattle, WA, United States 
      of America.
AD  - International Training and Education Center for Health (I-TECH), Seattle, WA, 
      United States of America.
LA  - eng
GR  - R21 TW010583/TW/FIC NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20200930
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Ambulatory Care/*economics
MH  - *Circumcision, Male/adverse effects
MH  - *Cost-Benefit Analysis
MH  - Decision Trees
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Postoperative Period
MH  - Text Messaging/economics
MH  - Zimbabwe
PMC - PMC7526887
COIS- The authors have declared that no competing interests exist.
EDAT- 2020/10/01 06:00
MHDA- 2020/12/16 06:00
PMCR- 2020/09/30
CRDT- 2020/09/30 17:12
PHST- 2019/12/14 00:00 [received]
PHST- 2020/09/16 00:00 [accepted]
PHST- 2020/09/30 17:12 [entrez]
PHST- 2020/10/01 06:00 [pubmed]
PHST- 2020/12/16 06:00 [medline]
PHST- 2020/09/30 00:00 [pmc-release]
AID - PONE-D-19-34591 [pii]
AID - 10.1371/journal.pone.0239915 [doi]
PST - epublish
SO  - PLoS One. 2020 Sep 30;15(9):e0239915. doi: 10.1371/journal.pone.0239915. 
      eCollection 2020.