OBJECTIVES: Innovation is increasing in integrated products combining a drug, a connected ‘smart’ administration device and an application that supports disease management. Specific evaluation frameworks for these combination products do not yet exist. We assessed how payers evaluate pricing and access potential of innovative digital health technologies that combines a drug, a ‘smart’ device and a companion application.

METHODS: 45 national or sub-national payers across European markets (France, Germany, Italy, Spain, the United Kingdom) were asked, via an online survey, what drives higher willingness to pay (WTP) and/or access for a drug, smart device and app combination product versus the same drug with a non-connected device and no app.

RESULTS: The attributes most payers across all markets agreed resulted in a higher WTP were: reduction in serious adverse events (64%); improvements in disease-relevant markers (57%, also ranked as the most important driver of price premiums); improvement to adherence (56%). Across most countries, data from randomised controlled trials (RCTs), rather than from a real-world setting was preferred, especially among French and German respondents. France and the UK had the highest proportion of payers open to price premiums. Some respondents from Germany, Italy and Spain suggested that ‘smart’ devices and companion apps for drugs may positively influence uptake and willingness to prescribe from physicians, but not result in a higher price.

CONCLUSIONS: The establishment of frameworks for evaluation of these innovative technologies is still in its infancy. Conventional evidence from RCTs is still largely preferred over real-world data, however, we argue that RCTs do not capture the real-world benefit provided by integrated drug and digital/technological advances. Instead, more pragmatic approaches to evidence generated in real-world settings and conditional reimbursement should be considered.