Cost and Cost-Effectiveness of mHealth Interventions to Promote Uptake of Antenatal Care (ANC) in Low- and Middle-Income Countries: A Scoping Review

Abstract

Mobile health (mHealth) innovations are increasingly being considered to improve antenatal care (ANC) uptake in low- and middle-income countries (LMICs). However, there is limited evidence of their value for money, which limits policymakers' ability to make decisions about sustainability and scale. This scoping review synthesizes available evidence on the cost and cost-effectiveness of mHealth interventions aimed at promoting ANC uptake in LMICs. Following the Arksey and O’Malley framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, we searched PubMed, Science Direct, and Google Scholar databases for peer-reviewed studies reporting economic evaluations. These included studies reporting cost-effectiveness, cost-benefit, or costing analyses of mHealth interventions targeting ANC, published between 2010 and 2025. Screening and data extraction were performed by two independent reviewers. Data was charted and synthesized narratively, and findings were presented in tables. From the 1,249 records screened, 10 studies met the inclusion criteria: seven cost-effectiveness analyses and three costing studies. Studies were from South Asia and sub-Saharan Africa, including India (n=3), Bangladesh (n=2), and one each from Nigeria, South Africa, Ghana, Iraq, and Malawi. Interventions included short message service (SMS) reminders, mobile job aids for community health workers, and integrated digital platforms. Improvements were reported in ANC outcomes such as early registration, four or more visits, and iron-folic acid consumption. Costs ranged from $0.0225 per SMS in Iraq to $29.33 per user in Malawi. Incremental cost-effectiveness ratios varied from $21 to $568 per disability-adjusted life year averted and were below prevailing country specific gross domestic product (GDP) per capita thresholds, though direct cross-study comparison is limited by differences in analytical perspective, time horizon, and modelling assumptions. Four studies adopted a societal perspective, four a program perspective, and one a health system perspective; five of the seven cost effectiveness analyses used the Lives Saved Tool for modelling. Evidence gaps identified included a lack of equity analyses, limited long-term sustainability data, and a need for standardized methodological approaches. Reviewed evidence suggests that mHealth interventions for ANC promotion in LMICs are a cost-effective approach to improving ANC uptake, although evidence is largely modelled rather than empirically observed and hence calls for cautious interpretation. The common use of the Lives Saved Tool across most cost-effectiveness studies suggests an emerging standardization in how mHealth cost-effectiveness is assessed. Some gaps remain, including the absence of equity analyses, limited long-term sustainability evidence, and underrepresentation of sub-Saharan Africa. Standardized cost-effectiveness analyses with a focus on equity are needed to ensure future mHealth investments align with universal health coverage goals and benefit women across all socioeconomic groups.