*Purpose: We have previously demonstrated the efficacy of a pharmacist-led, mHealth intervention on reducing medication errors and adverse events leading to reduce hospitalizations in kidney transplant recipients through an RCT. Here we report the economic impact of the TRANSAFE Rx RCT by assessing the costs and return on investment (ROI).

*Methods: This was an a priori planned economic analysis of the TRANSAFE Rx RCT; a 12-month, parallel arm, 1:1 randomized controlled clinical trial in adult KTX 6 to 36 months post-transplant (NCT03247322). All patients received usual post-transplant care, while those randomized to the intervention arm received supplemental clinical pharmacist-led medication therapy monitoring and management, via a smartphone-enabled mHealth app, integrated with risk-based televisits and home-based blood pressure and blood glucose monitoring. The clinical pharmacist conducted weekly risk assessments and recorded both pharmacological and nonpharmacological interventions performed throughout the study. We assessed estimated costs of hospitalizations using total charges multiplied by the 2019 CMS cost-to-charge ratio and assessing the ROI based on the costs saving vs. actual total costs required to deliver the intervention.

*Results: 136 patients were enrolled, 68 were randomized into each arm. The mean age was 50.2 years, 51.5% of patients were male and 58.8% were AA. The primary etiologies of ESRD were hypertension (92.6%) and diabetes (27.9%). As previously reported, the intervention led to a 56% absolute reduction in medication errors (p<0.001), a 45% lower incidence risk of grade 3 or higher adverse events (p=0.048) and significantly lower rates of hospitalization (1.08 vs. 0.65 hospitalizations per patient-year; p=0.005); 20 patients in the intervention arm had a total of 38 hospitalizations with 99 hospital days, while 25 patients in the control arm had a total of 62 hospitalizations with 195 hospital days. Costs of hospitalizations were $1,531,071 in the control arm and $667,605 in the intervention arm. Costs to deliver the intervention included pharmacist time (342 hrs; $26,744), $57,012 to build and maintain the mHealth app, $25,709 for smartphone data plans and $1,675 for BP/glucose devices and supplies, totaling $111,140. The ROI for this intervention is estimated to be $7.8 saved for each $1 invested as the intervention had a net hospitalization cost-reduction of $752,326, or $11,063 per patient-year.

*Conclusions: A pharmacist-led mHealth based intervention led to significantly fewer medication errors, adverse drug events and hospitalizations. The economic benefit of this intervention on reducing hospitalization costs is estimated to be $750,000, with a ROI of nearly 8 to 1.

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