JMIR Publications

ABSTRACT

Background:

Owing to the unique characteristics of digital health interventions (DHIs), there is a need for an approach tailored to economic evaluation that is distinct from that used for pharmacotherapy. However, the absence of clear guidelines in this area is a substantial gap in the evaluation framework.

Objective:

This study aimed to systematically review and compare the economic evaluation literature on DHIs and pharmacotherapy for the treatment of depression.

Methods:

We searched for articles published between October 2013 and October 2023 in Ovid-MEDLINE, Embase, Cochrane Library, and PsycINFO databases. We extracted data on the study characteristics, input parameters, and economic evaluation modeling components. Chi-square tests were used to analyze the frequency of various components across intervention types. A qualitative comparison was performed to assess the costs, effects, and modeling aspects of each intervention. The Consolidated Health Economic Evaluation Reporting Standard (CHEERS) checklist was used to evaluate the quality of the selected studies.

Results:

A total of 42 articles were included, of which 23 focused on DHIs and 19 on pharmacotherapy. Cost-utility analysis was predominantly used in pharmacotherapy (84.21%), whereas DHIs featured significantly fewer analyses (52.17%; P=.010). DHIs were more frequently used than usual care (52.17%) or waitlist controls (21.74%), whereas pharmacotherapy mainly involved active controls (89.47%, P=.000). Additionally, pharmacotherapy was more likely to be used in model-based studies (68.42%), whereas DHIs predominantly relied on trial-based studies (73.91%; P=.006). Although not significant, a notable trend was identified: the payer perspective was most commonly used in pharmacotherapy (52.48%), whereas approximately 30.43% of cases of its use in DHIs. Furthermore, studies with a time horizon exceeding 12 months were more common for pharmacotherapy (26.32%) than that for the DHIs (13.04%). Assessment using the CHEERS checklist indicated that pharmacotherapy generally had higher reporting quality, compared with that of DHIs in areas such as study parameters, comparators, time horizon, and discount rate.

Conclusions:

Compared with pharmacotherapy, DHIs involved a higher proportion of trial-based studies reporting short-term outcomes and studies with ambiguously defined cost items. This underscores the need for improved measurement and modeling to accurately capture the costs and effectiveness of DHIs.