JMIR Publications

ABSTRACT

Background:

Digital health applications are playing an increasingly important role in health care. While research on their efficacy is advancing, health economic studies are often lacking but are urgently needed to inform coverage decisions in healthcare systems.

Objective:

This rapid review aims to summarize the current economic evidence, the modeling practices, and the quality of health economic studies on digital health applications.

Methods:

Four electronic databases (PubMed, Cochrane Library, EconBiz and Web of Science) were searched. Furthermore, a systematic and unsystematic hand search was conducted. Studies were selected based on predefined inclusion criteria with only complete health economic studies being considered. Data were narratively synthesized, and the risk of bias was assessed using the Cochrane risk of bias tool 2 (RoB 2). Methodological quality was evaluated using the Consensus on Health Economic Criteria (CHEC) checklist and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). The review followed PRISMA guidelines for implementation and reporting.

Results:

Overall, 3,841 results were identified. After screening the full texts of 82 publications, seven studies were included in the final analysis. Four of the studies concluded that the app under review was cost-effective compared to the chosen control group. Most of the studies that provided economic evidence incorporated indirect costs and used a societal perspective. All studies employed cost-utility analyses (n=7), with the majority based on randomized controlled trials (RCTs) (n=5), considering the healthcare payer perspective (n=3). Standard care was commonly used as the control group (n=5). Benefits were measured using the EQ-5D (n=3) and/or condition-specific questionnaires (n=7). The incremental cost-effectiveness ratio (ICER), reported as costs per quality-adjusted life year (QALY), was the most frequent model outcome (n=4). On average, the quality of the economic evaluations was rated positively using the CHEERS 2022 and CHEC checklist. However, more than half of the RCTs underlying the health economic evaluations exhibited a high risk of bias.

Conclusions:

Digital health applications have the potential to be cost-effective and evaluations of these are of increasing interest. However, improvements in the reporting of RCT outcome data are necessary, and more studies are needed to establish standardized modeling practices.