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

Tanga, Abayneh Tunje LU ; Lundqvist, Pia LU ; Persson, Magnus C LU orcid ; Kristjánsdóttir, Gudrún LU orcid ; Vilhjálmsson, Runar LU and Jerene, Degu LU (2026) In Frontiers in Public Health 14. p.01-07
Abstract
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... (More)
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. (Less)
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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Frontiers in Public Health
volume
14
article number
1718940
pages
01 - 07
publisher
Frontiers Media S. A.
ISSN
2296-2565
DOI
10.3389/fpubh.2026.1718940
project
eHealth as an aid for facilitating and supporting self-management in families with long-term childhood illness – development, evaluation and implementation in clinical practice
language
English
LU publication?
yes
id
7be9ecd2-8da0-4ae4-9faa-65dc502df806
date added to LUP
2026-01-23 13:33:42
date last changed
2026-01-26 07:29:15
@article{7be9ecd2-8da0-4ae4-9faa-65dc502df806,
  abstract     = {{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.<br/><br/>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 (&lt;3 × GDP per capita; $3,636 for Ethiopia, 2023) guided interpretation.<br/><br/>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.<br/><br/>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.}},
  author       = {{Tanga, Abayneh Tunje and Lundqvist, Pia and Persson, Magnus C and Kristjánsdóttir, Gudrún and Vilhjálmsson, Runar and Jerene, Degu}},
  issn         = {{2296-2565}},
  language     = {{eng}},
  month        = {{01}},
  pages        = {{01--07}},
  publisher    = {{Frontiers Media S. A.}},
  series       = {{Frontiers in Public Health}},
  title        = {{Economic evaluation of digital health interventions to improve quality-adjusted life years in adolescents living with HIV in Ethiopia}},
  url          = {{http://dx.doi.org/10.3389/fpubh.2026.1718940}},
  doi          = {{10.3389/fpubh.2026.1718940}},
  volume       = {{14}},
  year         = {{2026}},
}