How much did it cost to develop and implement an eHealth intervention for a minority children population that overlapped with the COVID-19 pandemic

Authors: MONASHEFSKY, ALEXANDRA - Boston Children'S Hospital; ALON, DAR - Harvard School Of Public Health; BARANOWSKI, TOM - Children'S Nutrition Research Center (CNRC); BARREIRA, TIAGO - Syracuse University; CHIU, KELLY - Harvard Medical School; FLEISCHMAN, AMY - Harvard Medical School; GREEN, MELANIE - University At Buffalo; HUANG, SHIRLEY - Tufts University; SAMUELS, RONALD - Children'S Hospital At Montefiore; SOUSA, CAIO - Loyola Marymount University; Thompson, Deborah - Debbe; LU, AMY - National University Of The Northeast Argentina

Submitted to: Contemporary Clinical Trials
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/2/2022
Publication Date: 12/5/2022
Citation: Monashefsky, A., Alon, D., Baranowski, T., Barreira, T.V., Chiu, K.A., Fleischman, A., Green, M.C., Huang, S., Samuels, R.C., Sousa, C.V., Thompson, D.J., Lu, A.S. 2022. How much did it cost to develop and implement an eHealth intervention for a minority children population that overlapped with the COVID-19 pandemic? Contemporary Clinical Trials. 125. Article 107044. https://doi.org/10.1016/j.cct.2022.107044.
DOI: https://doi.org/10.1016/j.cct.2022.107044

Interpretive Summary: While eHealth interventions using active video games (AVGs) offer a method to help children exercise, especially during a pandemic where options are limited, there is limited data on costs associated with developing and implementing such interventions. We quantified the total trial costs of delivering our eHealth intervention (implementation of an AVG) among minority children during COVID-19, and categorized these costs into five subcategories: intervention material development, advertising and recruitment, intervention delivery, personnel salaries, and COVID-19-related equipment costs. Of the subcategories, intervention material development accounted for the largest portion, followed by personnel salaries. While the direct COVID-19-specific cost constituted less than 1% of the entire budget, the indirect effects were much larger and significantly impacted the trial. Future eHealth intervention investigators should budget and prepare for unexpected costs, such as recruitment challenges, to increase flexibility while maximizing intervention efficacy.

Technical Abstract: eHealth interventions using active video games (AVGs) offer an alternative method to help children exercise, especially during a pandemic where options are limited. There is limited data on costs associated with developing and implementing such interventions. We quantified the costs of delivering an eHealth RCT intervention among minority children during COVID-19. We categorized the total trial cost into five subcategories: intervention material development, advertising and recruitment, intervention delivery, personnel salaries, and COVID-19-related equipment costs. The total RCT cost was $1,927,807 (Direct: $1,227,903; Indirect: $699,904) with three visits required for each participant. The average cost per participant completing the RCT (79 participants/237 visits) was $24,403 (Direct: $15,543; Indirect: $8860). Due to no-shows and cancellations (198 visits) and dropouts before study completion (61 visits; 56 participants), 496 visits had to be scheduled to ensure complete data collection on 79 participants. If all 496 visits were from participants completing the three-visit protocol, that would correspond to 165 participants, bringing the average cost per participant down to $11,684 (Direct: $7442; Indirect: $4242). Of the subcategories, intervention material development accounted for the largest portion, followed by personnel salaries. While the direct COVID-19-specific cost constituted <1% of the entire budget, the indirect effects were much larger and significantly impacted the trial. RCTs typically involve significant resources, even more so during a pandemic. Future eHealth intervention investigators should budget and plan accordingly to prepare for unexpected costs such as recruitment challenges to increase flexibility while maximizing the intervention efficacy.