This Technology Should be Compared With? And Who for? The Digital Health Population Conundrum

OBJECTIVES: Digital health technologies (DHTs) have become more common interventions within healthcare over the past decade. DHTs can often be used across a wide range of pathways, rather than to treat specific health conditions. This leads to not having a clearly defined comparator in health economic evaluation. This research described the approaches to populations and comparators when evaluating the health economic impact of DHTs and some of the potential limitations.

METHODS: A series of expert panel discussions and interviews were undertaken to discuss approaches for evaluating digital health technologies, including the approach to capturing the population and selecting the relevant comparators. The results of the panel sessions were supplemented with pragmatic literature searches to develop a methods paper, detailing approaches and issues for evaluating DHTs.

RESULTS: There are two common approaches taken for evaluating DHTs. The first approach is to narrow the population in the evaluation to a specific indication, omitting some of the DHTs potential benefit. The second is to keep the population as broadly defined as possible, but to simplify the health economic evaluation to key costs, resources use, and health outcomes. This approach leads to omitting many of the potential benefits through simplifying the modelled decision problem. Issues with evaluating the population may still arise when evaluating DHTs due to the ease of access compared with other forms of care.

CONCLUSIONS: DHTs are likely to require much more localised and flexible models than other healthcare interventions to adapt to local care pathways, which may represent a different standard of care. Where narrower indications are sought, the value of DHTs is likely to be underestimated. Evidence generation should look to capture broader populations where possible. Decision makers should be supported to develop a framework to identify and discuss the risk, generalisability and unquantifiable benefit of adopting DHTs with wider populations.