{"doi":"10.1101/2024.11.26.24317997","title":"What does it cost to expand two-way texting for post-operative follow-up? A cost analysis in routine voluntary medical male circumcision settings in South Africa","abstract":"Up to 98% of adult voluntary medical male circumcision (VMMC) clients heal without adverse events (AEs) in South Africa and in the sub-Saharan Africa (SSA) region, yet all clients in South Africa (SA) are still required to attend in-person reviews, creating added work for providers and barriers for clients. A randomized controlled trial (RCT) using our fee-free, open-source, two-way texting (2wT) approach showed that males could independently monitor their healing with support from VMMC nurse-led telehealth and that 2wT was more cost-effective than routine visits for quality post-operative monitoring. The objectives of this costing activity were to assess the additive cost of 2wT vs. SoC during a stepped wedge design (SWD) expansion trial; costing an augmentation of 2wT with dedicated personnel during peak VMMC periods; and estimate the cost savings of 2wT from the payer perspective if scaled in routine VMMC settings. Data was collected from routine financial reports and complemented by previous RCT time-motion estimates. We conducted activity-based costing of SWD and peak season periods; sensitivity analysis estimated 2wT costs at scale. We included data from 6,842 males, with 2,586 (38%) opting for 2wT. 2wT participants attended an average of zero visits; SoC males had an average of 2 visits. Under 2wT, quality care markers improved and AE ascertainment increased while loss to follow-up (LTFU) decreased. Given a VMMC population of 10,000 adults, scenario analysis suggests that: 1) 2wT becomes cost neutral with 45% 2wT enrollment; 2) 2wT saves $0.29/client with 60% 2wT enrollment; and 3) 2wT saves $0.46/client with 80% 2wT enrollment. When implemented at scale, 2wT appears to significantly reduce costs to the healthcare system while improving the quality of post-operative care and requiring no additional client costs. 2wT should be expanded for eligible males across VMMC and other post-operative contexts in South Africa.","journal":"medRxiv","year":2024,"id":492504,"datarank":0.10397207708399181,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"self_citation_contribution":0.10397207708399181,"citation_network_contribution":0.0,"self_endowment_contribution":0.10397207708399181,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9477,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1276116,"name":"Isabella Fabens","orcid":null,"position":1,"is_corresponding":false},{"id":1062759,"name":"Geoffrey Setswe","orcid":"0000-0003-3646-0722","position":2,"is_corresponding":false},{"id":1275709,"name":"Khumbulani Moyo","orcid":"0009-0002-7213-2187","position":3,"is_corresponding":false},{"id":1062751,"name":"Jacqueline Pienaar","orcid":"0000-0002-6252-4534","position":4,"is_corresponding":false},{"id":1276117,"name":"Calsile Makhele","orcid":null,"position":5,"is_corresponding":false},{"id":1276120,"name":"Motshana Phohole","orcid":null,"position":6,"is_corresponding":false},{"id":1276118,"name":"Nelson Igaba","orcid":null,"position":7,"is_corresponding":false},{"id":1276119,"name":"Sizwe Hlongwane","orcid":null,"position":8,"is_corresponding":false},{"id":1062754,"name":"Maria Sardini","orcid":"0009-0000-1170-6373","position":9,"is_corresponding":false},{"id":653141,"name":"Tracy Qi Dong","orcid":"0000-0001-6769-608X","position":10,"is_corresponding":false},{"id":289068,"name":"Monisha Sharma","orcid":"0000-0002-7599-1561","position":11,"is_corresponding":false},{"id":597212,"name":"Hannock Tweya","orcid":"0000-0002-8247-1273","position":12,"is_corresponding":false},{"id":1062752,"name":"Felex Ndebele","orcid":"0000-0002-7499-7486","position":13,"is_corresponding":false},{"id":468682,"name":"Marrianne Holec","orcid":null,"position":14,"is_corresponding":false},{"id":467848,"name":"Caryl Feldacker","orcid":"0000-0002-8152-6754","position":15,"is_corresponding":false},{"id":1339209,"name":"Molly Unsworth","orcid":null,"position":0,"is_corresponding":true}],"reference_count":19,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T02:08:56.210382Z","pmid":"39649604","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}