EXPANDED VALUE MEASURES THROUGH BEHAVIOR CHANGE: AN INTERNATIONAL DELPHI CONSENSUS ON REIMBURSEMENT OF DIGITALLY ENABLED BEHAVIORAL INTERVENTIONS
Author(s)
Katarzyna Kolasa, PhD1, Andrew Kwist, MPH2, Fleur Levrat Guillen, PharmD3, Erin Carroll, MSc4, Fiona Pearce, BA, BSc, MPH5, Isabelle Durand-Zaleski, MPP, PhD, MD6, Jari Haverinen, MHsc, MSc7, CHARLOTTE Gordon, RN, PhD8, Hussain Abdulrahman Al-Omar, MSc, PhD9, Partha Kar, MD10, Bernhard Kulzer, PhD11, Sean Tunis, MSc, MD12, Youssof Oskrochi, MBBS, MS13, Michael Vallis, PhD14.
1Kozminski University, Warsaw, Poland, 2ABBOTT, San Francisco, CA, USA, 3Abbott diabetes care, London, United Kingdom, 4Policy Wisdom, Quebradillas, PR, USA, 5Agency for Care Effectiveness, Ministry of Health, Singapore, 6Assistance Publique Hopitaux de Paris URCEco, Paris, France, 7FinCCHTA, Oulu, Finland, 8Northumbria University, Newcastle Upon Tyne, United Kingdom, 9College of Pharmacy, King Saud University, Riyadh, Saudi Arabia, 10Portsmouth Hospitals NHS University Trust, Portsmouth, United Kingdom, 11Bad Mergentheim Diabetes Academy (FIDAM), Bad Mergentheim, Germany, 12Rubix Health, Baltimore, MD, USA, 13University College London, London, United Kingdom, 14Dalhousie University, Halifax, NS, Canada.
1Kozminski University, Warsaw, Poland, 2ABBOTT, San Francisco, CA, USA, 3Abbott diabetes care, London, United Kingdom, 4Policy Wisdom, Quebradillas, PR, USA, 5Agency for Care Effectiveness, Ministry of Health, Singapore, 6Assistance Publique Hopitaux de Paris URCEco, Paris, France, 7FinCCHTA, Oulu, Finland, 8Northumbria University, Newcastle Upon Tyne, United Kingdom, 9College of Pharmacy, King Saud University, Riyadh, Saudi Arabia, 10Portsmouth Hospitals NHS University Trust, Portsmouth, United Kingdom, 11Bad Mergentheim Diabetes Academy (FIDAM), Bad Mergentheim, Germany, 12Rubix Health, Baltimore, MD, USA, 13University College London, London, United Kingdom, 14Dalhousie University, Halifax, NS, Canada.
OBJECTIVES: To develop international consensus on a definition and classification framework for digital behavioral interventions (DBI) and whether health technology assessment (HTA) and pricing and reimbursement (P&R) guidelines should evolve to adequately capture the value of behavioral and health outcomes generated by DBI.
METHODS: A Delphi-style approach was designed to reflect cross-sector, multinational perspectives from 11 experts across 9 countries through a 1) pre-roundtable survey, 2) virtual roundtable surveys and discussion, and 3) post-roundtable survey. The expert population included HTA experts, clinicians, behavioral scientists, nurse researchers and patient advocates. Insights were informed by a literature review assessing if and how DBIs deliver measurable behavioral outcomes that translate into statistically significant health outcomes. (n=3,843, 22 RCTs included). Structured voting and discussion informed consensus development.
RESULTS: Experts aligned on a definition for DBI and three behavioral outcome categories: attitudinal change, habit formation, and reinforced habit formation. Majority of experts (8/11) supported reimbursement of DBI with continuous feedback loops that reinforce patient attitudes and healthy habit formation (demonstrated by clinical evidence programs), whereas 5/11 supported reimbursement of interventions that demonstrate formation of healthy habits translating from improvements in patient attitudes, and none supported reimbursement of interventions that lead to improvements in attitudes alone, with heterogeneity across countries. Over 80% agreed behavior change across all categories from DBI can lead to measurable health outcomes. Clinical surrogate endpoints and longer-term disease progression outcomes were universally accepted for reimbursement (100%). Quality of life outcomes were less consistently accepted (higher acceptance for reinforced behavior change than for earlier stage behavioral outcomes).
CONCLUSIONS: Experts consensus was met on: definitions for DBI, behavioral outcomes categories, that current frameworks inadequately capture their value with high costs of inaction, and ultimately the need to better integrate behavioral outcomes into value assessment. This represents a practical and necessary step toward efficient, sustainable, and patient-centered healthcare decision-making.
METHODS: A Delphi-style approach was designed to reflect cross-sector, multinational perspectives from 11 experts across 9 countries through a 1) pre-roundtable survey, 2) virtual roundtable surveys and discussion, and 3) post-roundtable survey. The expert population included HTA experts, clinicians, behavioral scientists, nurse researchers and patient advocates. Insights were informed by a literature review assessing if and how DBIs deliver measurable behavioral outcomes that translate into statistically significant health outcomes. (n=3,843, 22 RCTs included). Structured voting and discussion informed consensus development.
RESULTS: Experts aligned on a definition for DBI and three behavioral outcome categories: attitudinal change, habit formation, and reinforced habit formation. Majority of experts (8/11) supported reimbursement of DBI with continuous feedback loops that reinforce patient attitudes and healthy habit formation (demonstrated by clinical evidence programs), whereas 5/11 supported reimbursement of interventions that demonstrate formation of healthy habits translating from improvements in patient attitudes, and none supported reimbursement of interventions that lead to improvements in attitudes alone, with heterogeneity across countries. Over 80% agreed behavior change across all categories from DBI can lead to measurable health outcomes. Clinical surrogate endpoints and longer-term disease progression outcomes were universally accepted for reimbursement (100%). Quality of life outcomes were less consistently accepted (higher acceptance for reinforced behavior change than for earlier stage behavioral outcomes).
CONCLUSIONS: Experts consensus was met on: definitions for DBI, behavioral outcomes categories, that current frameworks inadequately capture their value with high costs of inaction, and ultimately the need to better integrate behavioral outcomes into value assessment. This represents a practical and necessary step toward efficient, sustainable, and patient-centered healthcare decision-making.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA246
Topic
Health Technology Assessment, Patient-Centered Research
Topic Subcategory
Systems & Structure
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity), Nutrition, Personalized & Precision Medicine