Abstract
Background
mhealth interventions are increasingly adopted to improve cancer care in low- and middle-income countries. Despite their potential, evidence on cost-effectiveness in oncology remains limited in India. This study evaluates the cost-utility of the OncoCare mobile application for oncology patients.
Methods
A trial-based cost-utility analysis was conducted alongside a six-month randomized controlled trial (n = 342; App: 168, Control: 174). Costs were estimated from the provider's perspective using a micro-costing approach, including development costs and prorated annual maintenance costs. Health outcomes were measured using the EORTC QLQ-C30 and mapped to EQ-5D-5L utilities via an ordinal-logit algorithm, applying the Indian EQ-5D-5L tariff. QALYs were calculated using the area-under-the-curve method. Incremental cost-effectiveness ratios were estimated, with uncertainty explored through bootstrap replications, cost-effectiveness planes, and cost-effectiveness acceptability curves. Sensitivity analyses assessed alternative cost assumptions.
Results
The per-patient incremental cost of OncoCare was ₹597 (₹642 including maintenance). Mean six-month QALYs were 0.249 in the App group compared to 0.239 in the control group. The adjusted incremental QALY gain was 0.0107 (95% CI: 0.0042–0.0174). The base-case ICER was ₹55,600 per QALY, well below both the opportunity-cost threshold for India (approximately ₹2.1 lakh/QALY) and the WHO's GDP-per-capita heuristic. The probability of cost-effectiveness exceeded 82% at ₹100,000/QALY and 95% at ₹150,000/QALY. Headroom analysis confirmed the cost-effectiveness, even with per-patient costs three- to five-fold higher.
Conclusion
OncoCare is a cost-effective digital intervention in Indian oncology, achieving measurable QALY gains at low incremental cost. These findings support its integration into cancer care pathways and national digital health strategies.
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