Cost Effectiveness and mHealth…

A couple of recent articles commenting on mHealth and cost effectiveness have highlighted the difficulty this concept presents if we’re looking at a particular intervention rather than how it interacts with the wider healthcare system.

First up is a mobile news article by Cian O’Sullivan at GoMoNews titled: “mHealth: FDA approves incredibly cost-effective mobile ultrasound”… …”an mHealth launch today strikes me as being particularly smart and cost-effective. By combining the computing power of Microsoft smartphones with a reasonably small hardware add-on, Seattle-based Mobisante is releasing what is perhaps the cheapest ultrasound system in the world – and it has just been approved by the FDA

Here are the issues I have with this:

1) The FDA approval is no big deal and it’s rather obvious it would get that as Laptop based ultrasound devices are already approved and widely distributed. The smartphone is a computer in the eyes of the FDA.
2) The “reasonably small hardware add on” is the same reasonably small hardware add on that a medic could use with her laptop. It’s a completely normal probe so there’s no actual reason for it to be cheaper or require less testing/calibration. In 2011 the software is the important piece of this pie.
3) “The entire system will cost less than $10k – in an industry where the average ultrasound unit retails for between $20k and $100k“. This is a ridiculous comparison as it compares this device with something with dedicated controlling hardware and doesn’t take into account the sales, upgrade or life time ownership costs that this device will encounter.
4) The article continues to refer to this as a “true application of mobile healthcare. It’s not just some tracking application. This could allow ultrasounds to be performed much cheaper, in a far greater variety of locations. It applies the processing power of a smartphone in a very intelligent way – by reducing the size of the usually required ultrasound machine to something you can actually put in your pocket

Cian seems to be driven by a tech goal of making everything smaller – rather than adding value or appreciating how this will actually be used. Where’s the evidence that medics conducting ultrasound really want smaller screens? Where’s the evidence that medics will be capable of achieving quality reports/patient outcomes without the control abilities that competitive devices offer? Would you actually want to put a $10,000 mobile phone in your pocket? Would you as a patient want to see a Doctor using a probe they just took out of their pocket? How can we regulate this technology so that disadvantaged patients in other regions of the world aren’t being diagnosed with dummy/non-working look-a-like probes attached to smartphones?

The second article is by Ano Lobb, an instructional designer for the Master of Health Care Delivery program at Dartmouth College. He asks a very good question “Would MHealth Profit From Cost-Effectiveness Research?” and makes a great point when he explains how mhealth offers “BYOD (Bring Your Own Device)” opportunities but he’s applied what I think are some really poor quality arguments to make his case:

> “Research shows that providing pap smear tests every 3 years extends life by 70 days at a cost of $500. Give the test every year and you extend life by 71 days at a cost of $1500. Currently 63 percent of women have an annual pap smear, 18 percent have them every three years

This has got to be one of the most unsubstantiated claims I’ve ever read. While I’m not a bit surprised that the author is male I’d be very surprised if he has any idea what these numbers (70 days, 71 days) mean? I wonder if he’s aware of the benefits of a regular program of pap smear screening and appropriate follow up? I wonder if he appreciates that patients having annual tests are often doing this on the guidance of their clinicians? I wonder if he appreciates that before the introduction of the Pap test the leading cause of cancer death for females was carcinoma of the cervix? etc etc

In my opinion mobiles have a critically important role to play in the prevention of cervical cancer but it’s not by saying ‘spend money on mHealth instead of wasting it on Pap Smears’ but by educating providers so that they can learn to leverage mobile tools. If you’re looking for ideas think about SMS scheduling of appointments, SMS appointment reminders, SMS’s to follow up with patients who have abnormal results, educational mobile video content, etc.

In the future as affordable, simple to use, reliable and accurate viral DNA tests arrive on the market I have no doubt the importance of mobiles will increase dramatically as these increasingly capable personal devices become viewed as the only efficient means to deliver the instructional videos, manage the counterfeit issues, take the important history, make the referral to local health services etc etc

> “Providers such as also provide a service that benefits large populations at a relatively low cost to drug marketers

As highlighted here before, I’ve yet to see any tangible evidence that suggests that unless there was a single, global shortcode solution (which could – and should – be created by organisations such as the GSMA and WHO) combined with integrated packaging codes, sticking primitive scratch card solutions to the packaging of meds won’t do much but force scammers to adopt new strategies (for example devising their own scratch card scams as they’ve proven themselves capable of doing eg. with the calling card business).

Piracy of cheap medicines in emerging markets will only ever be controlled by better supply chain control and as we’ve seen even in the most affluent countries we haven’t managed to do that. It may be sad to admit but I think that it’s unlikely that the application of another band aid to the problem will prove cost effective or be enough to change things.

> “Folks who are trying to sell a new CT Scan, on the other hand, are pushing an exceedingly large capital investment that will necessarily lead to vast increase in high cost services (more scans). The marginal health benefits of CT scans, compared to less expensive imaging tests, or in some cases no imaging test at all, are to date not clear

I think it’s obvious that anyone who thinks a CT Scan only offers “marginal” or “unclear” health benefits is clearly unaware of the improved outcomes that CT diagnostic imaging provides us with. But instead of criticizing this expensive option why not herald examples of how mHealth is improving the efficiency of these expensive pieces of diagnostic equipment? SMS appointment reminders can not only help ensure patients turn up but they can be used to provide patients with notification of appointments that may become available at short notice. Why not think of leveraging SMS to help manage 24×7 operation of diagnostic facilities? I personally wouldn’t decline a scan at 3am if it saved me some money and/or a 6 month wait…

> “Finally, might this inspire docs to consider the costs of what they prescribe? Could this lead to the prescription of mhealth apps, and other typically non-Rx tech solutions?

This has already happened, Doctors in the NHS prescribe a wide variety of non-Rx products eg. gym membership, pets etc. As for mHealth apps these are currently being sold in and I don’t know a top brand pharma company that hasn’t already developed an app or have one under wraps being tested with patients. Check back next week when I’ll be posting some video interviews from the Healthcare Innovation Expo in London. These will capture some of the key mHealth app innovators rolling out Pharma market solutions here in Europe. Let me know if you’d like a ringside ticket…

About 3G Doctor

The Corporate Blog of 3G Doctor
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