Cutting Through the Confusion: Selecting Comparators in Digital Health Technology Evaluation

OBJECTIVES: Over the past decade, digital health technologies (DHTs) have become increasingly common healthcare interventions and their prevalence is growing further. DHTs can be used across a range of pathways, rather than for the treatment of specific health conditions. This may lead to many issues, including not having a clearly defined comparator in health economic evaluation. Furthermore, pathways differ locally and regionally which makes identifying a relevant comparator especially challenging. This research describes the approaches to this issue when evaluating the health economic impact of DHTs and recommends suggestions for future considerations.

METHODS: A pragmatic literature review was undertaken to identify research that had sought to provide clarity or had outlined a framework for the evaluation of DHTs. This was conducted using unstructured searches on PubMed and Google Scholar. Following this, a series of expert panel discussions and interviews were undertaken whereby the approaches to evaluating DHTs were discussed.

RESULTS: Regardless of the purpose of the DHT, the choice of comparator will be a function of how the intervention interacts with non-digital health care. The DHT may complement or substitute other types of health care delivery or administration systems. The relevant comparator may be easier to identify in settings where the intervention being implemented is in an area where a DHT is already used. The exception is where the new DHT has a wider aspect than the current DHT.

CONCLUSIONS: Identifying the relevant comparator can be difficult when evaluating DHTs. Comparators may differ at local, regional and national levels, particularly where a DHT is replacing part, or all, of a face-to-face care pathway. Decision makers should be supported to develop a framework for the evaluation of DHTs. Each DHT should have an adapted scoping approach, depending on the elements involved, to ensure a suitable approach to evaluation is used.