Cost effectiveness review of text messaging, smartphone application, and website interventions targeting T2DM or hypertension

Abstract

Digital health interventions have been shown to be clinically-effective for type 2 diabetes mellitus (T2DM) and hypertension prevention and treatment. This study synthesizes and compares the cost-effectiveness of text-messaging, smartphone application, and websites by searching CINAHL, Cochrane Central, Embase, Medline and PsycInfo for full economic or cost-minimisation studies of digital health interventions in adults with or at risk of T2DM and/or hypertension. Costs and health effects are synthesised narratively. Study quality appraisal using the Consensus on Health Economic Criteria (CHEC) list results in recommendations for future health economic evaluations of digital health interventions. Of 3056 records identified, 14 studies are included (7 studies applied text-messaging, 4 employed smartphone applications, and 5 used websites). Ten studies are cost-utility analyses: incremental cost-utility ratios (ICUR) vary from dominant to €75,233/quality-adjusted life year (QALY), with a median of €3840/QALY (interquartile range €16,179). One study finds no QALY difference. None of the three digital health intervention modes is associated with substantially better cost-effectiveness. Interventions are consistently cost-effective in populations with (pre)T2DM but not in populations with hypertension. Mean quality score is 63.0% (standard deviation 13.7%). Substandard application of time horizon, sensitivity analysis, and subgroup analysis next to transparency concerns (regarding competing alternatives, perspective, and costing) downgrades quality of evidence. In conclusion, smartphone application, text-messaging, and website-based interventions are cost-effective without substantial differences between the different delivery modes. Future health economic studies should increase transparency, conduct sufficient sensitivity analyses, and appraise the ICUR more critically in light of a reasoned willingness-to-pay threshold.Registration: PROSPERO (CRD42021247845).

Telemedicine in Improving Glycemic Control Among Children and Adolescents With Type 1 Diabetes Mellitus: Systematic Review and Meta-Analysis

“…However, there are specific telemedicine cost analysis studies that may provide assistance with cost considerations. In a recently published study on the cost-effectiveness of telemedicine interventions, smartphone app, SMS text messaging, and website interventions were confirmed to be cost-effective without substantial differences among the different delivery modes [ 70 ]. A study by Elliott et al [ 71 ] showed that smart wearable devices increase short-term costs but their HbA 1c -lowering benefits will provide sufficient long-term health benefits and cost savings to justify the costs as long as the effects last into the medium term.…”

Digital interventions for self-management of prediabetes: A scoping review

“…The need for more evidence regarding multimodal digital health interventions and their mechanisms of impact has been highlighted by others [57][58][59][60]. Recent work assessing the (cost) effectiveness of digital interventions of different modalities to support type 2 diabetes self-management have demonstrated that while cost-effectiveness might be similar across some of the common modalities [61], text message and app-based interventions may be more effective overall and have greater reach than web-based interventions [62]. Future work should seek to address these questions for interventions targeting prediabetic populations.…”