The objective of this study was to critically assess and review empirical evidence on the cost-effectiveness of Mobile Health (mHealth) interventions for older adults. We systematically searched databases such as Pubmed, Scopus, and Cumulative Index to Nursing and Allied Literature (CINAHL) for peer-reviewed economic evaluations published in English from 2007 to 2018. We extracted data on methods and empirical evidence (costs, effects, incremental cost-effectiveness ratio) and assessed if this evidence supported the reported findings in terms of cost-effectiveness. The consolidated health economic evaluation reporting standards (CHEERS) checklist was used to assess the reporting quality of the included studies. Eleven studies were identified and categorized into two groups: complex smartphone communication and simple text-based communication. Substantial heterogeneity among the studies in terms of methodological approaches and types of intervention was observed. The cost-effectiveness of complex smartphone communication interventions cannot be judged due to lack of information. Limited evidence of cost-effectiveness was found for interventions related to simple text-based communications. Comprehensive economic evaluation studies are warranted to assess the cost-effectiveness of mHealth interventions designed for older adults. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.

Background: A randomized controlled trial of the SMART4MD tablet application was conducted for persons with mild cognitive impairment (PwMCI) and their informal caregivers to improve or maintain quality of life. Objective: The objective was to conduct economic evaluation of SMART4MD compared to standard care in Sweden from a healthcare provider perspective based on a 6-month follow-up period. Methods: Three hundred forty-five dyads were enrolled: 173 dyads in the intervention group and 172 in standard care. The primary outcome measures for PwMCI and informal caregivers were quality-adjusted life years (QALY). The results are presented as incremental cost-effectiveness ratios, and confidence intervals are calculated using non-parametric bootstrap procedure. Results: For PwMCI, the mean difference in total costs between intervention and standard care was (sic)12 (95%CI: -2090 to 2115) (US$ =(sic) 1.19) and the mean QALY change was -0.004 (95%CI: -0.009 to 0.002). For informal caregivers, the cost difference was -(sic)539 (95%CI: -2624 to 1545) and 0.003 (95%CI: -0.002 to 0.008) for QALY. The difference in cost and QALY for PwMCI and informal caregivers combined was -(sic)527 (95%CI: -3621 to 2568) and -0.001 (95%CI: -0.008 to 0.006). Although generally insignificant differences, this indicates that SMART4MD, compared to standard care was: 1) more costly and less effective for PwMCI, 2) less costly and more effective for informal caregivers, and 3) less costly and less effective for PwMCI and informal caregivers combined. Conclusion: The cost-effectiveness of SMART4MD over 6 months is inconclusive, although the intervention might be more beneficial for informal caregivers than PwMCI.

This contribution corrects cost data from our previously published version in which the 6-month cost data was not censored at baseline and 6-month survey dates. Consequently, the average costs for persons with mild cognitive impairment (PwMCI) and their informal caregivers include costs that occurred outside the initial 6-month period for both intervention and control groups. In this erratum, we have repeated the analysis after appropriately censoring the costs. The results led to numerical differences. However, as both the intervention and control groups have been treated exactly the same, the differences between groups remain insignificant and the general interpretation of the results stand as presented in the original publication. The interpretation of the results in terms of cost-effectiveness has changed for informal caregivers, shifting from "dominant" to "not cost-effective", and for dyads, shifting from "less costly and less effective" to "more costly and less effective". Consequently, ICER and CEAC curves have also changed (see Corrected Fig. 1). However, these changes did not affect the conclusion of the article. 

Background

We evaluated the effectiveness of the SMART4MD tablet app in improving the quality of lives of persons with mild cognitive impairment (PwMCI) and their caregivers, through medication reminders and health appointment alerts. 

Methods and Findings

An 18-month pragmatic randomized controlled trial was conducted in Spain and Sweden from December 2017 to September 2020 and included 1078 PwMCIs and their informal caregivers. 

For PwMCI, there was no significant effect in quality of life or medication adherence. However, quality of life measured by QALY was significantly improved for both caregivers and dyads in the intervention group. A dropout rate of around 40% was noted in both intervention and control groups.

Conclusions

The overall results suggest that the SMART4MD app does not add additional benefits beyond standard care over the 18-month study period except for informal caregivers. 

Background

The study evaluated the cost-effectiveness of a customised, tablet-based application (SMART4MD) which is developed to support people living with mild cognitive impairment and their informal caregivers.  

Methods

In a pragmatic randomized controlled trial, people with mild cognitive impairment (PwMCI) and their informal caregivers were randomised to intervention and control groups. Intervention group was asked to use SMART4MD app for 18 months.  Control group received standard care. Healthcare costs, quality-adjusted life years (QALY), incremental cost-effectiveness ratios were measured (ICER) in 345 Swedish PwMCI and their informal caregivers and 347 Spanish PwMCI.

Results

The analysis showed higher incremental costs and lower QALYs for Swedish PwMCI than controls whereas higher incremental costs and higher QALYs were observed for Spanish PwMCI. The intervention was found to be not cost-effective for the Swedish informal caregivers with an ICER of €78,000/QALY. In contrast, the Spanish site found the intervention cost-effective for PwMCI yielding an ICER of €3,337/QALY.

Discussion

The divergent findings regarding cost-effectiveness for PwMCI in Sweden and Spain necessitate further research with extended follow-up, ideally involving an increased sample size and conducted in different national contexts.