Economic Evaluation of Digital Health Interventions in Oncology: A Targeted Literature Review

OBJECTIVES: Cost-effectiveness analysis (CEA) of digital health interventions (DHIs) is crucial for equitable resource allocation. However, information on the CEA of DHIs in oncology remains sparse due to diverse patient profiles, outcome uncertainties, and high treatment costs. This review synthesises existing evidence on the CEA of DHIs in oncology.

METHODS: We searched PubMed (2019-2024) using relevant keywords such as "digital", "cancer", and "cost-effectiveness". We included randomised controlled trials, observational studies, systematic reviews, and meta-analyses reporting CEA with incremental cost-effectiveness ratio (ICER) values. Non-DHI studies and those on non-cancer populations were excluded. Two reviewers independently extracted the data on demographics, model characteristics, ICER, willingness-to-pay (WTP) thresholds, and CEA findings, with discrepancies resolved through consensus.

RESULTS: We identified 54 records, including 13 CEA articles on DHIs for analysis (7 from PubMed, 6 from Google). These comprised 4 systematic reviews and 9 individual CEA studies. The majority focused on cancer screening technologies (10/13, 76.92%), predominantly breast (6/13, 46.15%) and lung (2/13, 15.38%) cancers. Markov models were used in 5 studies (38.46%), and 5 studies (38.46%) assessed cost per quality-adjusted life year (QALY) gained. Common WTP thresholds ranged from US$20,000 to US$100,000 per QALY, with US$50,000 per QALY being most prevalent.

The studies were primarily from the US (6/13, 46.15%), Europe (4/13, 30.77%), and Asia (3/13, 23.08%). Sensitivity analyses were conducted in 10 studies (76.92%), confirming robust CEA findings with sensitivity to intervention costs and effectiveness. Mean ICER values for breast cancer screening ranged from US$5,971.5 to US$17,149 per QALY, while for lung cancer, they ranged from US$10,000 to US$90,000 per QALY.

CONCLUSIONS: Most studies found DHIs to be cost-effective, especially in cancer screening. However, CEAs using standardised methods on diverse cancer populations are recommended for evidence-informed policy decisions about DHIs in oncology. More health economic studies should be encouraged on DHIs used for therapeutic purposes in oncology.