OBJECTIVES: Healthcare systems worldwide aim to enhance patient-centered care while managing limited resources. Digital interventions present a promising solution to optimize healthcare delivery effectively. This systematic review evaluates the cost-effectiveness of digital interventions in chronic disease management from a Value-Based Healthcare (VBHC) perspective, emphasizing patient-centered outcomes and efficient resource allocation.

METHODS: A comprehensive search of seven databases (Medline, Embase, Web of Science, Cochrane, CINAHL, Scopus, Econlit) was conducted. Digital interventions were defined as hybrid care, remote monitoring, telemedicine with sensors, and mobile health applications. An artificial intelligence tool (ASReview) supported the screening of titles and abstracts. Full-text review and data extraction of study characteristics, economic analysis, and outcomes were performed by two independent researchers. The VBHC perspective was assessed by considering the balance of cost and patient-reported outcomes (PROs) in economic evaluations. The Cochrane's Risk of Bias tool and the Consensus on Health Economic Criteria checklist evaluated study quality.

RESULTS: Out of 814 papers screened, 23 articles met the inclusion criteria, reflecting a global scope with primary studies from the United States (n=6), Canada (n=5), Australia (n=5), and Europe (n=3). These articles primarily focused on chronic obstructive pulmonary disease (COPD) (n=10), diabetes (n=11), and cardiovascular disease (CVD) (n=6), with additional studies addressing other conditions (n=14). Of these, 15 cost-effectiveness analyses demonstrated economic benefits of digital interventions in congestive heart failure and COPD, reporting Incremental Cost-Effectiveness Ratio (ICER) values ranging from $7,337 to $44,832 per Quality-Adjusted Life Year (QALY). PROs were reported in 56% of the studies of which 78% was mostly evaluated alongside costs.

CONCLUSIONS: Preliminary results suggest that most digital interventions in chronic disease management are cost-effective. However, the incorporation of disease-specific patient-reported outcome measures in economic evaluations remains limited, despite its potential to provide more patient-centered insights into the effectiveness of digital interventions, supporting optimal resource allocation.