JMIR Publications

ABSTRACT

Background:

Digital health interventions (DHIs) implemented through various technologies have experienced substantial growth and uptake in the healthcare sector in recent years. While the clinical effectiveness of DHIs for children and adolescents has been relatively well studied, much less is known about the value for money of these interventions.

Objective:

This study aimed to systematically review economic evaluations of DHIs targeted at paediatric and adolescent populations. The study also sought to review potential methodological issues that are specific to economic evaluations of DHIs with the purpose of informing future research priorities.

Methods:

We conducted a database search in PubMed from 2011 to 2021, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Two authors independently screened titles and abstracts of search results to determine which studies were eligible for full-text review. We generated a data abstraction procedure based on recommendations from the Panel on Cost-Effectiveness in Health and Medicine. A narrative analysis was used to synthesise the quantitative data due to the heterogeneity across the studies. We extracted methodological issues related to study design, analysis framework, cost and outcome measurement, and methodological assumptions regarding the health economic evaluation.

Results:

We included 22 articles that assessed cost-effectiveness of DHI interventions for children and adolescents. Most articles evaluated interventions delivered through online portals or text messaging, most frequently within the healthcare specialties of mental health and maternal, newborn and child health. In 18 out of 22 articles, DHI was found cost-effective or cost-saving compared to the non-digital standard of care. The key drivers of cost-effectiveness included population coverage, cost components, intervention effect size and scale-up, and study perspective. The methodological challenges commonly identified in the articles were related to study design (n=17), costing (n=11) and economic modelling (n=9).

Conclusions:

This is the first systematic review of economic evaluations of DHIs targeting paediatric and adolescent populations. Study perspective, cost and outcome measurement and modelling assumptions varied widely across the studies and were not always appropriately justified, suggesting a need for further methodological research and guidance for designing and conducting economic evaluations of DHIs for this population.