Cost-consequence analysis of a digital health-enabled non-communicable disease management intervention in Ghana

Abstract Background Diabetes and hypertension pose a major non-communicable disease (NCD) burden in Ghana, yet care remains reactive and resource-intensive. Although digital health interventions may improve screening, continuity of care, and patient engagement, economic evidence, particularly transparent assessments of multiple costs and outcomes, remains limited in low- and middle-income settings. The Akoma Pa initiative integrates digital health tools to address these gaps. There is a lack of evidence on the cost-consequences of digital health interventions in Ghana. This study evaluates the costs and consequences of the intervention compared with conventional standard care to inform resource allocation and policy decisions for sustainable NCD management in Ghana. Methods A retrospective cost-consequence analysis was conducted comparing the Akoma Pa digital health program with conventional care for diabetes and hypertension in Christian Health Association of Ghana (CHAG) facilities between January and December 2023. A total of 705 adults with hypertension and/or diabetes were systematically sampled from 16 facilities (8 intervention, 8 comparator) using proportionate-to-size allocation and random selection from clinic registers; only consenting participants who completed follow-up were analysed. Costs were disaggregated into capital, recurrent, personnel, and training categories. Consequences were reported as a profile of outcomes, including clinical changes (HbA1c, systolic blood pressure, body mass index) and process indicators (follow-up rates). Results The total annual program cost for the intervention was $508,443.89, compared with $529,882.28 for the comparator, indicating a cost-saving of approximately $21,438. The intervention demonstrated superior clinical effectiveness with greater mean reductions in HbA1c (-2.10% vs. -1.68%), Systolic Blood Pressure (-54.38 mmHg vs. -51.88 mmHg), and BMI (-4.42 kg/m² vs. -0.61 kg/m²). Process outcomes revealed a significant impact on engagement, with the intervention achieving an 89% follow-up rate compared to 36.5% in standard care. Conclusion The Akoma Pa intervention presents a dominant economic profile, offering superior clinical and engagement outcomes at a lower total health system cost than conventional care. The efficiency gains from digital supply chain management and tele-counselling support the integration of such digital ecosystems into national NCD strategies.