Presentation (CTI)

OBJECTIVES: Stroke is one of the leading causes of death and disability across the world. Digital health technologies, such as telemedicine, mobile health (mHealth) applications, and wearable devices, have potential to deliver better health outcomes from stroke care. However, there are concerns that these technologies may increase the health inequality. Distributional cost-effectiveness analysis (DCEA) is a framework to assess the trade-off between efficiency and health equity.With the aim of informing decision-making about the efficiency-equity trade-off from digital health, this study 1) identifies factors that are relevant for the evaluation of digital health technologies in stroke within the DCEA framework, 2) reviews how metrics for such factors can be specified, and 3) identifies potential sources for such metrics by different socioeconomic group.
METHODS: To demonstrate the efficiency-equity trade-off, the DCEA framework synthesise information about the effectiveness of different health technologies and the health outcomes for different social groups.
RESULTS: The effectiveness of digital health technologies depends on the acceptability, affordability, compliance, cost and effect. Each of these factors may be different for socioeconomic groups defined by location, sex, age, marital status, education, employment, and income. This would imply that different levels of gains in health outcomes (e.g. quality-adjusted life years) might arise for different social groups and thus impose additional health inequality. The data required for the application of the DCEA framework will be assessed, and strategies for specification of relevant metrics and potential sources for empirical evidence is illustrated and discussed.
CONCLUSIONS: Digital Health interventions have huge potential for transforming stroke care and introduce innovation across different parts of the stroke trajectory including prevention, acute care, and rehabilitation. These interventions may also increase health disparities. Therefore, the health economic analyses of digital health for stroke should consider both the clinical and socioeconomic dimensions, so the benefits of digital health innovations can be equitably distributed.