JMIR Publications

ABSTRACT

Background:

Complex digital interventions that integrate electronic patient-reported outcome measures (ePROM) into clinical practice in cancer have the potential to improve quality of life, increase survival, and reduce health resource use and costs. Such systems can help oncology patients self-manage chemotherapy symptoms, reduce workloads for clinicians through automated decision support, and resolve problems earlier. However, there is a need for more research on the cost-effectiveness of such interventions.

Objective:

This review aims to (1) summarize and evaluate the quantitative and qualitative evidence related to the cost-effectiveness and economic evaluation methods of ePROM-integrated interventions, and (2) extract data and validate assumptions useful for health economic modelling of ePROM-based treatment strategies.

Methods:

We searched for original English-language papers published on or before March 2025 on Ovid (including MEDLINE and Embase), Scopus, and the International Health Technology Assessment Database (INAHTA) using search strings that combined terms related to ePROMs, health economics, and cancer/oncology. We included papers reporting health economic-related outcomes for ePROM interventions designed for adult cancer populations and excluded screening tools and conference abstracts.

Results:

We included 34 publications from 27 unique studies, and identified and analyzed 26 ePROM-integrated interventions within these. Most (23/26) of the included interventions explicitly described some form of alert handling and automated decision support based on remote ePROM monitoring. 5/34 publications presented full cost-utility analysis results, of which 3 were characterized by high uncertainty and a lack of clear differences in costs and health outcomes between ePROMs and standard care, while 2 presented strong evidence of cost-effectiveness due to quality-of-life improvements, reduced hospitalizations, and potentially more autonomy in health-related travel (e.g., ePROM-monitored patients can drive or walk to the hospital instead of using taxis or ambulances). A further 5/34 publications reported partial health economic results (e.g., cost-consequence, budget impact), of which 1 detected no difference in strategies, while 4 reported lower health resource use and costs of ePROMs, mainly due to hospitalization reductions. 12/27 studies included a qualitative component but mostly focused on user experience and design-related themes; only 2/12 of these addressed economic-specific themes (e.g., changes in workflow and resource use due to ePROM implementation and integration), indicating some potential for time saving due to ePROM monitoring.

Conclusions:

There is some evidence that ePROM-integrated interventions can be cost-effective in cancer care, but the evidence base remains limited. Where evidence does exist, cost-effectiveness appears driven by reduced hospitalization and improved quality of life. Qualitative research within the included studies rarely addressed economic questions. We provide a detailed parameter extraction for use in future economic modelling and recommend research priorities, including quantitative mapping of ePROM symptom data onto health resource use patterns, and qualitative work exploring how ePROM implementation affects clinical workloads and patient-perspective costs.