Resum

Background: To calculate the cost-effectiveness of an mHealth supported Pathway of Care for clinically stable people living with HIV managed at the Hospital Clinic, Barcelona, Spain. This enables individuals to receive HIV treatment information on their smart-phone via the mHealth App. Methods: The 547 study participants of the EmERGE study mainly used three HIV outpatient services, the foci of the costing study. Unit costs were calculated and linked to mean per patient year (MPPY) use of HIV services. Data on use of services were collected retrospectively one-year before and prospectively one-year after the introduction of the mHealth App, enabling annual cost of HIV service provision to be estimated. Annual costs were combined with biomedical and social outcome data - CD4 count, Viral Load, respectively, before or after the introduction of the App. Costs were calculated in Euros. Results: Mean outpatient visits decreased from 7.6 (95%CI: 7.4 to 7.9) to 6.9 (95%CI: 6.7 to 7.2) MPPY. Annual costs were €7978 (95%CI €7947 - 8,568) pre-mHealth and €7915 (95%CI €7,889 - 7,942) post-mHealth a 1% reduction; ARVs comprised 92-93% of annual costs. No significant differences in CD4 counts were observed between periods and average viral load remained undetectable during both periods. Conclusion: Annual cost pre- and post- mHealth Pathway decreased by 1%, an efficient intervention; ARVs were the main cost drivers. Participants remained clinically stable after the introduction of mHealth Pathway of Care. Future efficiencies can be anticipated with the introduction of the Pathway across the clinical site. Additional analyses will include investigating differences between the use and cost between the three outpatient clinics, the PAM13 and, PROQOL-HIV scores of the EmERGE participants and their out-of-pocket expenditures.