Economic Evaluation of Digital Health Interventions: Methodological Issues and Recommendations for Practice

Gomes, Manuel; Murray, Elizabeth; Raftery, James

doi:10.1007/s40273-022-01130-0

Cited by 41 publications

(70 citation statements)

References 41 publications

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“…These analyses should consider the end-user perspective as well as the potential benefits for the health care system in general [ 168 , 169 ]. Digital health interventions appear to be cost-effective [ 170 ], although reports often present varying, inconclusive results [ 171 ]. Although it is often mentioned that one of the potential advantages of digital health interventions, particularly in the long term, may be a significant decrease in health care costs [ 172 ], the upfront expenses of developing the digital intervention might be substantial.…”

Section: Resultsmentioning

confidence: 99%

“…Despite the increasing importance of conducting economic evaluations of digital health care interventions, only 2% (1/55) of the studies included in our reviews reported economic evaluation data [ 73 ]. Recent documents from the World Health Organization [ 168 ] and the International Training and Education Center for Health [ 169 ] at the University of Washington in the United States, as well as a recent review [ 171 ], present a practical overview of how to perform economic evaluations.…”

Section: Resultsmentioning

confidence: 99%

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Designing, Developing, Evaluating, and Implementing a Smartphone-Delivered, Rule-Based Conversational Agent (DISCOVER): Development of a Conceptual Framework

Dhinagaran¹,

Martinengo²,

Ho³

et al. 2022

JMIR Mhealth Uhealth

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Background Conversational agents (CAs), also known as chatbots, are computer programs that simulate human conversations by using predetermined rule-based responses or artificial intelligence algorithms. They are increasingly used in health care, particularly via smartphones. There is, at present, no conceptual framework guiding the development of smartphone-based, rule-based CAs in health care. To fill this gap, we propose structured and tailored guidance for their design, development, evaluation, and implementation. Objective The aim of this study was to develop a conceptual framework for the design, evaluation, and implementation of smartphone-delivered, rule-based, goal-oriented, and text-based CAs for health care. Methods We followed the approach by Jabareen, which was based on the grounded theory method, to develop this conceptual framework. We performed 2 literature reviews focusing on health care CAs and conceptual frameworks for the development of mobile health interventions. We identified, named, categorized, integrated, and synthesized the information retrieved from the literature reviews to develop the conceptual framework. We then applied this framework by developing a CA and testing it in a feasibility study. Results The Designing, Developing, Evaluating, and Implementing a Smartphone-Delivered, Rule-Based Conversational Agent (DISCOVER) conceptual framework includes 8 iterative steps grouped into 3 stages, as follows: design, comprising defining the goal, creating an identity, assembling the team, and selecting the delivery interface; development, including developing the content and building the conversation flow; and the evaluation and implementation of the CA. They were complemented by 2 cross-cutting considerations—user-centered design and privacy and security—that were relevant at all stages. This conceptual framework was successfully applied in the development of a CA to support lifestyle changes and prevent type 2 diabetes. Conclusions Drawing on published evidence, the DISCOVER conceptual framework provides a step-by-step guide for developing rule-based, smartphone-delivered CAs. Further evaluation of this framework in diverse health care areas and settings and for a variety of users is needed to demonstrate its validity. Future research should aim to explore the use of CAs to deliver health care interventions, including behavior change and potential privacy and safety concerns.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Designing, Developing, Evaluating, and Implementing a Smartphone-Delivered, Rule-Based Conversational Agent (DISCOVER): Development of a Conceptual Framework

Dhinagaran¹,

Martinengo²,

Ho³

et al. 2022

JMIR Mhealth Uhealth

View full text Add to dashboard Cite

show abstract

“…Once an application is developed and operational in a market, the marginal cost of treating an additional patient is quite low and thus more scalable. However, insurance coverage for app-based therapy is still very limited [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

A Review of Functional Outcomes after the App-Based Rehabilitation of Patients with TKA and THA

Bäcker

Pförringer

et al. 2022

JPM

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Following the outbreak of SARS-CoV-2, several elective surgeries were cancelled, and rehabilitation units were closed. This has led to difficulties for patients seeking access to rehabilitation in order to achieve the best possible outcome. New applications with or without sensors were developed to address this need, but the outcome has not been examined in detail yet. The aim of this study was to perform a systematic literature review on smart phone applications for patients suffering from hip and knee osteoarthritis after arthroplasty. The MEDLINE/PubMed and Google databases were queried using the search term “[APP] AND [ORTHOPEDIC]” according to PRISMA guidelines. All prospective studies investigating rehabilitation applications reporting the functional outcome in hip and knee osteoarthritis after arthroplasty were included. The initial search yielded 420 entries, but only 9 publications met the inclusion criteria, accounting for 1067 patients. In total, 518 patients were in the intervention group, and 549 patients were in the control group. The average follow-up was 9.5 ± 8.1 months (range: 3 to 23.4 months). Overall, significantly lower A-VAS values were observed for the interventional group in the short term (p = 0.002). There were no other significant differences observed between the two groups. Smart phone applications provide an alternative to in-person sessions that may improve access for patients after total joint arthroplasty. Our study found there are significant improvements in the short term by using this approach. In combination with a blue-tooth-enabled sensor for isometric exercises, patients can even receive real-time feedback after total knee arthroplasty.

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“…DHI development incurs significant research and development costs prior to launch, and the resources consumed during development can be very different from pharmaceuticals and physical medical devices. DHIs have other unique characteristics that can affect development processes and thus costs, including faster evolution, active and more dynamic user input ( 21 ). DHI development costs are usually incurred for content and software design, website and graphic design, digital platform development and regulatory approval processes.…”

Section: Introductionmentioning

confidence: 99%

“…The aim of this study is to describe, estimate, and present the associated cost components and total cost of developing and delivering the Narrative Experiences Online (NEON) Intervention, using current recommendations for costing DHIs ( 11 , 19 , 21 , 22 ).…”

Section: Introductionmentioning

confidence: 99%

Development and delivery cost of digital health technologies for mental health: Application to the Narrative Experiences Online Intervention

et al. 2022

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BackgroundThe increasing development and use of digital health interventions requires good quality costing information to inform development and commissioning choices about resource allocation decisions. The Narrative Experiences Online (NEON) Intervention is a web-application that delivers recorded mental health recovery narratives to its users. Two randomized controlled trials are testing the NEON Intervention in people with experience of psychosis (NEON) and people experiencing non-psychosis mental health problems (NEON-O).AimThis study describes and estimates the cost components and total cost of developing and delivering the NEON Intervention.Materials and methodsTotal costs for the NEON Trial (739 participants) and NEON-O Trial (1,024 participants) were estimated by: identifying resource use categories involved in intervention development and delivery; accurate measurement or estimation of resource use; and a valuation of resource use to generate overall costs, using relevant unit costs. Resource use categories were identified through consultation with literature, costing reporting standards and iterative consultation with health researchers involved in NEON Intervention development and delivery. Sensitivity analysis was used to test assumptions made.ResultsThe total cost of developing the NEON Intervention was £182,851. The largest cost components were software development (27%); Lived Experience Advisory Panel workshops (23%); coding the narratives (9%); and researchers' time to source narratives (9%). The total cost of NEON Intervention delivery during the NEON Trial was £118,663 (£349 per NEON Intervention user). In the NEON-O Trial, the total delivery cost of the NEON Intervention was £123,444 (£241 per NEON Intervention user). The largest cost components include updating the narrative collection (50%); advertising (19%); administration (14%); and software maintenance (11%). Uncertainty in the cost of administration had the largest effect on delivery cost estimates.ConclusionOur work shows that developing and delivering a digital health intervention requires expertise and time commitment from a range of personnel. Teams developing digital narrative interventions need to allocate substantial resources to curating narrative collections.Implications for practiceThis study identifies the development and delivery resource use categories of a digital health intervention to promote the consistent reporting of costs and informs future decision-making about the costs of delivering the NEON Intervention at scale.Trial registrationNEON Trial: ISRCTN11152837, registered 13 August 2018, http://www.isrctn.com/ISRCTN11152837. NEON-O Trial: ISRCTN63197153, registered 9 January 2020, http://www.isrctn.com/ISRCTN63197153.

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Economic Evaluation of Digital Health Interventions: Methodological Issues and Recommendations for Practice

Cited by 41 publications

References 41 publications

Designing, Developing, Evaluating, and Implementing a Smartphone-Delivered, Rule-Based Conversational Agent (DISCOVER): Development of a Conceptual Framework

Designing, Developing, Evaluating, and Implementing a Smartphone-Delivered, Rule-Based Conversational Agent (DISCOVER): Development of a Conceptual Framework

A Review of Functional Outcomes after the App-Based Rehabilitation of Patients with TKA and THA

Development and delivery cost of digital health technologies for mental health: Application to the Narrative Experiences Online Intervention

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