Economic evaluation of digital health interventions to improve quality-adjusted life years in adolescents living with HIV in Ethiopia

Résumé

Introduction: The rapid expansion of mobile phone access has enabled low-cost SMS interventions to support adherence to antiretroviral therapy (ART). Although text messaging improves adherence and retention in HIV care, its cost-effectiveness for enhancing quality of life remains uncertain, particularly among adolescents in resource-limited settings. This study evaluated whether SMS reminders improve retention in care and quality-adjusted life years (QALYs) among adolescents living with HIV in Ethiopia. We hypothesized that SMS reminders would increase adherence and retention, leading to measurable gains in quality of life. Methods: A 6-month economic evaluation was conducted from the health system perspective, comparing daily SMS reminders plus standard care vs. standard care alone. HRQoL was measured using the EuroQol EQ-5D-3L instrument, which includes five domains: mobility, self-care, usual activity, pain/discomfort, and anxiety/depression. Utility values were derived using the Zimbabwean EQ-5D-3L value set as a proxy for Ethiopia and converted into QALYs. Costs were categorized as fixed (planning, system development, training) and variable (personnel, SMS communication, equipment, and overhead), valued in 2023 US dollars (USD; 1 USD = 54.7442 ETB). The Incremental Cost-Effectiveness Ratio (ICER) was calculated as ΔCost/ΔQALY. The WHO-CHOICE cost-effectiveness threshold (<3 × GDP per capita; $3,636 for Ethiopia, 2023) guided interpretation. Results: Daily SMS reminders were cost-effective according to WHO thresholds, with an ICER of $1,037.00 per QALY gained. Accounting for potential retention improvements, the ICER decreased to $864.00 per QALY gained. Intervention participants had higher utility scores (0.9515 vs. 0.9030) and QALYs (0.4760 vs. 0.4510) compared to controls. Discussion: SMS-based adherence interventions offer a cost-efficient approach to improving ART outcomes by enhancing adherence and retention. Anxiety/depression and pain/discomfort were key determinants of QALYs. Future research should assess long-term cost-effectiveness and scalability in resource-limited settings. Trial Registration: PACTR202107638293593.

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