JMIR Publications

ABSTRACT

Background:

eHealth applications are on the rise and are frequently considered to constitute a promising strategy for cost containment in healthcare, particularly if the applications aim to support the elderly population. The elderly population is not the only major eHealth stakeholder; eHealth suppliers, caregivers, funding bodies and health authorities are also likely to attribute value to eHealth applications. However, they can differ in their value attribution because they are affected differently by eHealth costs and benefits. Therefore, any assessment of the value of eHealth application requires considering multiple stakeholders in a holistic and integrated assessment.

Objective:

textA holistic and reliable value assessment of eHealth applications requires a profound understanding of the application’s costs and benefits. The first step in measuring costs and benefits is identifying the relevant costs and benefit categories that the eHealth application affects. We conducted a scoping review to support the identification process of the relevant direct and indirect costs and benefits by providing an overview of the aspects that economic evaluations have incorporated so far.

Methods:

We conducted a systematic search of the literature through December 2019. We included papers on eHealth applications with online/digital contact possibilities between clients and healthcare providers (mobile health applications) and applications for self-management, telehomecare, telemedicine, telemonitoring, telerehabilitation, and active healthy ageing technologies for the elderly population 65 years old or older. We included studies that focused on any type of economical evaluation including costs and benefits measures.

Results:

Our search identified 54 papers with economic evaluations. These papers considered a range of different types of costs and benefits. Costs pertained to implementation activities and operating activities related to the eHealth application. Benefits (or consequences) could be categorized according to stakeholder groups, i.e., elderly patients, caregivers, and healthcare provider organizations. These benefits could further be divided into stakeholder-specific outcomes and resource utilization. Some cost and benefit types have received more attention than others. Patient outcomes have, for instance, been predominantly captured via quality of life considerations and various types of physical health status indicators. From a resource utilization perspective, a strong emphasis has been placed on home care visits and hospital usage.

Conclusions:

Economic evaluations of eHealth applications are gaining momentum, and studies have shown considerable variety regarding the costs and consequences that they include. We contribute to the body of literature by providing a detailed and up-to-date framework of cost and benefit categories that any interested stakeholder can use as a starting point to conduct an economic evaluation in the context of independent living of the elderly.