Economic Evaluations of Digital Health Interventions: Is Existing Guidance Being Used?

OBJECTIVES: The UK’s National Institute of Clinical Excellence (NICE) published guidance on demonstrating digital health intervention (DHI) economic value recommends a budget impact model (BIM) for all DHIs and a cost-effectiveness/cost-utility analysis (CEA) for ‘high-risk’ interventions that carry elevated cost of commission, purchase, or implementation. The purpose of this review was to assess alignment of published DHI economic work with NICE’s assessment standards.

METHODS: Standard 17 and 18 of NICE’s 2018 “Evidence standards framework for digital health technologies” were used to create a 7-criteria checklist for each type of economic analysis (7 items for BIMs; 7 items for CEAs). A literature review was conducted in PubMed to identify economic analyses of DHIs published between 1-January-2019 and 14-November-2023. Details on the type of economic analysis, study location, DHI intervention (e.g., web-based, prescription, etc.), and results were abstracted. Economic evaluations were assessed (1=Yes, 0=No/Not Applicable) against the relevant checklist items. Total score per article was calculated and stratified by evaluation category (CEA/BIM).

RESULTS: Seven articles examining economic evaluations for 7 unique DHIs in the United States (n=2), Hong Kong (n=1), Germany (n=1), Nigeria (n=1), China (n=1), and Australia (n=1) were identified. No study reported >1 type of economic evaluation. The majority (6/7) of studies reported CEAs alone; one article reported a BIM analysis. Of CEAs reported, all 6 studies met a minimum of 4 of 7 criteria: 1 study included all seven while 3 studies integrated 6/7 criteria. The single BIM integrated 6/7 of criteria. Authors of 5 CEAs reported their results met established cost-effectiveness/cost-saving thresholds.

CONCLUSIONS: Our review found that published DHI economic analyses generally met applicable NICE standards by model type, however, cost-effective analyses were more common while few publications included a budget impact analysis as recommended.