Economic Evaluation of Digital Health Interventions: Methodological Issues and Recommendations for Practice, 2022, Gomes et al

Abstract

Health care interventions are increasingly being delivered through digital technologies, offering major opportunities for delivering more health gains from scarce health care resources. Digital health interventions (DHIs) raise distinct challenges for economic evaluations compared with drugs and medical devices, not least due to their interacting, evolving features. The implications of the distinctive nature of DHIs for the methodological choices underpinning their economic evaluation is not well understood. This paper provides an in-depth discussion of distinct features of DHIs and how they might impact the design, measurement, analysis and reporting of cost-effectiveness analysis conducted alongside both randomised and non-randomised studies. These include aspects related to choice of comparator, costs and benefits assessment, study perspective and type of economic analysis. We argue that typical methodological standpoints, such as taking a health service perspective, focusing on health-related benefits and adopting cost-utility analyses, as typically adopted in the economic evaluation of non-digital technologies (pharmaceutical drugs and medical devices), are unlikely to be appropriate for DHIs. We illustrate how these methodological aspects can be appropriately addressed in an evaluation of a digitally supported, remote rehabilitation programme for patients with Long Covid in England. We highlight several methodological considerations for improving practice and areas where further methodological work is required.

Key Points for Decision Makers

• The distinct challenges posed by digital health interventions (DHIs) for economic evaluation are not well understood.
• Compared with standard technologies such as drugs and medical devices, digital technologies tend to evolve faster over time, require active user input, interact more dynamically with user and environment, have distinct pricing and lead to diffused non-health impacts.
• This can have important implications for the economic evaluations of DHIs with respect to the choice of comparator, study perspective, measurement of costs and effects and type of economic analysis.

Open access, https://link.springer.com/article/10.1007/s40273-022-01130-0