Digital Health Technologies Assessment Based on Patient-Reported Outcome Measures (PROMs): Virtual Reality (VR) in the Treatment of Specific Phobias
Author(s)
Ignacio José López-Loureiro, PhD1, Janet Puñal-Rioboo, MSc1, Ewa Pawlowska, PhD2, Yolanda Triñanes-Pego, PhD3, Patricia Gómez-Salgado, PhD4.
1Avalia-t (ACIS), Santiago de Compostela, Spain, 2Avaliat ACIS, Santiago de Compostela, Spain, 3Sergas, Santiago de Compostela, Spain, 4Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
1Avalia-t (ACIS), Santiago de Compostela, Spain, 2Avaliat ACIS, Santiago de Compostela, Spain, 3Sergas, Santiago de Compostela, Spain, 4Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
OBJECTIVES: This study aimed to assess the efficacy of VR-based exposure therapy versus traditional exposure methods (in vivo or imaginative) for the treatment of specific phobias. Particular attention was given to standardized and validated PROMs in line with Health Economics and Outcomes Research (HEOR) principles to enhance the clarity and practical relevance of the findings for clinical and policy-making contexts.
METHODS: A systematic review was conducted following PRISMA guidelines using the Cochrane, MEDLINE, and Embase databases. Randomized controlled trials reporting PROMs that assessed anxiety and fear were included to evaluate VR-based and traditional exposure therapies. Two reviewers independently screened studies using the Covidence platform. A random-effects meta-analysis was performed to quantitatively synthesize the effect of treatments.
RESULTS: Out of 1,892 screened records, seven randomized controlled trials met the inclusion criteria, addressing flying phobia (n=4), arachnophobia (n=2), and acrophobia (n=1). Four studies were published between 2000 and 2006, with the remaining studies published in 2010, 2013, and 2019. Considerable variability was observed in the PROMs employed, even among studies targeting the same type of phobia. More than ten distinct instruments were employed across studies to evaluate anxiety and fear related outcomes. Consequently, the meta-analysis combined data from different PROMs, selecting one scale per study. The efficacy of VR-based therapy compared with traditional therapies could not be clearly established, and further comparisons were limited by methodological heterogeneity
CONCLUSIONS: Evidence does not support definitive conclusions regarding the efficacy of VR compared with traditional therapies. The outdated nature of most included studies, rapid advances in immersive technology, and PROMs heterogeneity compromise the quality of analyses. Therefore, findings should be interpreted cautiously. Future research should incorporate modern VR platforms, standardized outcome measures, and HEOR-aligned frameworks to improve consistency and comparability.
METHODS: A systematic review was conducted following PRISMA guidelines using the Cochrane, MEDLINE, and Embase databases. Randomized controlled trials reporting PROMs that assessed anxiety and fear were included to evaluate VR-based and traditional exposure therapies. Two reviewers independently screened studies using the Covidence platform. A random-effects meta-analysis was performed to quantitatively synthesize the effect of treatments.
RESULTS: Out of 1,892 screened records, seven randomized controlled trials met the inclusion criteria, addressing flying phobia (n=4), arachnophobia (n=2), and acrophobia (n=1). Four studies were published between 2000 and 2006, with the remaining studies published in 2010, 2013, and 2019. Considerable variability was observed in the PROMs employed, even among studies targeting the same type of phobia. More than ten distinct instruments were employed across studies to evaluate anxiety and fear related outcomes. Consequently, the meta-analysis combined data from different PROMs, selecting one scale per study. The efficacy of VR-based therapy compared with traditional therapies could not be clearly established, and further comparisons were limited by methodological heterogeneity
CONCLUSIONS: Evidence does not support definitive conclusions regarding the efficacy of VR compared with traditional therapies. The outdated nature of most included studies, rapid advances in immersive technology, and PROMs heterogeneity compromise the quality of analyses. Therefore, findings should be interpreted cautiously. Future research should incorporate modern VR platforms, standardized outcome measures, and HEOR-aligned frameworks to improve consistency and comparability.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HTA112
Topic
Clinical Outcomes, Health Technology Assessment
Disease
Mental Health (including addition)