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Original research article
Cost-effectiveness of a text message programme for the prevention of recurrent cardiovascular events
  1. Edward Burn1,
  2. Son Nghiem1,
  3. Stephen Jan2,
  4. Julie Redfern2,
  5. Anthony Rodgers2,
  6. Aravinda Thiagalingam3,4,
  7. Nicholas Graves1,
  8. Clara K Chow2,3,4
  1. 1 Queensland University of Technology, Brisbane, Queensland, Australia
  2. 2 The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
  3. 3 Department of Cardiology, Westmead Hospital, Sydney, Australia
  4. 4 Westmead Clinical School, University of Sydney, Sydney, Australia
  1. Correspondence to Clara K Chow, Cardiology, The George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, Sydney, NSW 2050, Australia; cchow{at}


Objective To estimate the cost-effectiveness of Tobacco, Exercise and Diet Messages (TEXT ME), a text message-based intervention that provides advice, motivation, information and support to improve health-related behaviours.

Methods A lifetime Markov model was used to estimate major vascular events (myocardial infarctions and strokes) avoided, quality-adjusted life years (QALYs) gained, costs to the health system and the incremental cost per QALY gained. The model was informed by data from a randomised controlled trial of TEXT ME, with evidence from systematic reviews and meta-analyses used to estimate the effects of changes in risk factors on the risk of major vascular events. Expected costs and health outcomes were estimated with uncertainty surrounding these characterised using probabilistic sensitivity analysis and a number of scenario analyses.

Results For a target population of 50 000 patients with documented coronary heart disease, the intervention is expected to lead to 563 fewer myocardial infarctions, 361 fewer strokes and 1143 additional QALYs. TEXT ME is expected to lead to an overall saving of $10.56 million for the health system over the patients’ lifetimes. The intervention can therefore be considered cost-saving and health-improving. Neither parameter nor structural uncertainty had a significant impact on the conclusion that TEXT ME is cost-effective.

Conclusions The provision of TEXT ME is predicted to lead to better health outcomes and an overall saving in costs for the health system.

Trial registration number identifier: ACTRN12611000161921.

  • cost effectiveness
  • mHealth
  • secondary prevention of cardiovascular disease
  • text-messaging interventions
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  • Contributors EB, SN supervised by NG conducted the economic analysis. EB and CC drafted the paper. JR, SF, AR, AT and CC (principal investigator) were involved in the design, implementation and interpretation of the TEXT ME trial. All authors contributed to reviewing and commenting on this paper and analyses.

  • Funding This health economic evaluation was made possible through funding support from a peer-reviewed competitive award from the BUPA Foundation. The TEXT ME study was supported by the National Heart Foundation of Australia Grant-in-Aid (G10S5110). Dr ChowCKC is funded by a Career Development Fellowship cofunded by the National Health and Medical Research Council (NHMRC) (1033478) and National Heart Foundation (11 S6016) and Sydney Medical Foundation Chapman Fellowship. Dr RedfernJR is funded by an NHMRC Career Development Fellowship (1061793) cofunded with a National Heart Foundation Future Fellowship (G160523). None of the funders had any role in the design, analysis or writing or approving of the manuscript prior to submission. This work was supported by peer-reviewed grants from the National Heart Foundation of Australia Grant-in-Aid (G10S5110) and a BUPA Foundation Grant.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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