How can we measure the effects of digital health interventions in economic evaluations?

Digital health technologies offer us the opportunity of receiving care and self-managing our own health wherever we may be.

Interventions based on digital health technologies are not typical healthcare interventions. While adopting them often means providing care at reduced costs, their effects are multiple and can go beyond the patients’ health.

Our new systematic review explores how to measure the effects of digital health interventions.

Given their widespread applications, it is now very important to explore how to calculate the value for money of digital health interventions to make the best use of limited healthcare resources.

To explore the economic literature on this topic, the MIDAS Theme in the ARC North West Coast has recently undertaken a systematic review on how the effects of digital health interventions can be measured.

Digital health is here to stay

The use of digital health technologies has increased in recent years, especially during the COVID-19 pandemic. For example, during the onset of the pandemic, it has been estimated that 90% of GP consultations were remote.
While face-to-face healthcare services have been resuming, healthcare interventions based on digital health technologies are likely to become commonplace.

Why calculating the value for money of digital health interventions is different

When researchers evaluate a new healthcare intervention, one of the key questions is: does it represent value for money?

Answering this question means calculating the costs and benefits of the intervention and any competing alternatives. While calculating the costs is more straightforward, calculating the benefits is often challenging. In economic evaluations, benefits are usually calculated using the quality-adjusted life years or QALYs which combine the health and survival gains that patients get from receiving an intervention.

[To find out more about QALYs, watch our short vlog here]

However, the following question may arise: are QALYs appropriate when the effects of an intervention go beyond the health and survival of patients?
This is the case of digital health interventions, where you may ask:
• Are patients able to better access healthcare services thanks to the digital health intervention?
• Is the time to diagnosis reduced?
• Is safety still ensured?
• Can the digital health intervention depersonalise how healthcare services are provided?

Consider the multiple impacts of digital health interventions

In our systematic review, we searched the literature for any relevant information on how the effects of digital health interventions can be measured in economic evaluations.

We found the following:

• Traditional approaches in economic evaluations are based on calculating a cost per QALY gained by the new intervention. If this cost per QALY is within a certain threshold, then the intervention is deemed as cost-effective.
This can still be done when evaluating digital health interventions, but more actions are needed.
• Digital health interventions are multi-faceted as they impact on multiple people (e.g., patients, caregivers, healthcare professionals and organisations) and on multiple aspects – not only the health and survival of patients but also on the whole experience of providing and receiving healthcare.
This means that identifying all the potential impacts from a digital health intervention is key.
• Even when a digital health intervention is deemed as cost-effective, it is worth exploring how fair the distribution of costs and effects is. Will the intervention benefit only a certain sub-group of technology-skilled people? Will it be available in deprived areas? Will all the healthcare professionals be able to use it?

Doing a traditional cost-effectiveness analysis is not normally enough in digital health

Exploring the economic value of digital health interventions is not only a matter of determining how cost-effective they are: identifying who is impacted and how, and how digital health interventions impact on equity is key too.
Read the full review here : https://doi.org/10.1177/0272989X221132741 =

Reference:
Benedetto V, Filipe L, Harris C, Spencer J, Hickson C, Clegg A. Analytical Frameworks and Outcome Measures in Economic Evaluations of Digital Health Interventions: A Methodological Systematic Review. Medical Decision Making. 2022;0(0). doi:10.1177/0272989X221132741

Authors of this summary:
• Dr Valerio Benedetto: Methodological Innovation, Development, Adaptation & Support (MIDAS) Theme, NIHR Applied Research Collaboration North West Coast (ARC NWC); Applied Health Research hub, University of Central Lancashire (UCLan).
• Dr Luís Filipe: MIDAS Theme, NIHR ARC NWC; Faculty of Health & Medicine, Lancaster University.
• Catherine Harris: MIDAS Theme, NIHR ARC NWC; Applied Health Research hub, UCLan.
• Joseph Spencer: Applied Health Research hub, UCLan.
• Carmel Hickson: Public Advisers’ Forum; Applied Health Research hub, UCLan.
• Professor Andy Clegg: MIDAS Theme, NIHR ARC NWC; Applied Health Research hub, UCLan.

Contact for further information:
Dr Valerio Benedetto
ARCNWC-MIDAS@uclan.ac.uk
Twitter: @valesschloss @arc_nwc