Systematic Review and Critique of Methods for Economic Evaluation of Digital Mental Health Interventions

Janković, Dina; Bojke, Laura; Marshall, David C.; Gonçalves, Pedro; Churchill, Rachel; Melton, Hollie; Brabyn, Sally; Gega, Lina

doi:10.1007/s40258-020-00607-3

Cited by 18 publications

(25 citation statements)

References 29 publications

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“…The key differences between DHIs and non-digital health interventions, such as pharmaceuticals and medical devices, and their implications for economic evaluations are summarised in Table 1 and discussed in greater detail below. The discussion of each of the methodological issues is based on the author’s experience with designing and analysing economic evaluation of DHIs [ 22 – 27 ] and development of guiding principles for the evaluation of DHIs [ 9 , 15 , 28 ], and several systematic reviews of the applied literature across different health settings [ 8 , 11 – 14 , 29 , 30 ]. Illustrative examples for each of these points are summarised in Table 2 .…”

Section: Distinct Aspects Of Digital Health Interventions (Dhis) and Implications For Economic Evaluationmentioning

confidence: 99%

“…While the challenges associated with choice of a comparator are not exclusive to the economic evaluation of DHIs, there are some distinct aspects to consider when defining a comparator in this context [ 8 , 30 ]. Irrespective of the purpose of the DHI, the choice of comparator will be a function of how the intervention interacts with non-digital health care.…”

Section: Distinct Aspects Of Digital Health Interventions (Dhis) and Implications For Economic Evaluationmentioning

confidence: 99%

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

2022

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Health care interventions are increasingly being delivered through digital technologies, offering major opportunities for delivering more health gains from scarce health care resources. Digital health interventions (DHIs) raise distinct challenges for economic evaluations compared with drugs and medical devices, not least due to their interacting, evolving features. The implications of the distinctive nature of DHIs for the methodological choices underpinning their economic evaluation is not well understood. This paper provides an in-depth discussion of distinct features of DHIs and how they might impact the design, measurement, analysis and reporting of cost-effectiveness analysis conducted alongside both randomised and non-randomised studies. These include aspects related to choice of comparator, costs and benefits assessment, study perspective and type of economic analysis. We argue that typical methodological standpoints, such as taking a health service perspective, focusing on health-related benefits and adopting cost-utility analyses, as typically adopted in the economic evaluation of non-digital technologies (pharmaceutical drugs and medical devices), are unlikely to be appropriate for DHIs. We illustrate how these methodological aspects can be appropriately addressed in an evaluation of a digitally supported, remote rehabilitation programme for patients with Long Covid in England. We highlight several methodological considerations for improving practice and areas where further methodological work is required.

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Section: Distinct Aspects Of Digital Health Interventions (Dhis) and Implications For Economic Evaluationmentioning

confidence: 99%

Section: Distinct Aspects Of Digital Health Interventions (Dhis) and Implications For Economic Evaluationmentioning

confidence: 99%

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

2022

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“…A recent review of economic evaluations of digital mental health interventions [ 30 ] found that the methods for costing these interventions varied greatly between studies. In this study, the cost of the digital component of interventions/controls and their maintenance was assumed to be zero in the base case, assuming that, if the intervention is rolled out nationally, the marginal cost per patient would be negligible.…”

Section: Methodsmentioning

confidence: 99%

Cost Effectiveness of Digital Interventions for Generalised Anxiety Disorder: A Model-Based Analysis

Janković

Gonçalves

Gega

et al. 2021

PharmacoEconomics Open

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Background Digital interventions (DIs) are increasingly being used in mental health care, despite limited evidence regarding their value for money. This study aimed to evaluate the cost effectiveness of DIs for generalised anxiety disorder (GAD), in comparison with alternative care options, from the perspective of the UK health care system. Methods An open-source decision analytic cohort model was used to extrapolate the results of a network meta-analysis over a patient’s lifetime and estimate the costs and outcomes (quality-adjusted life-years) of DIs and their comparators. The net monetary benefit (NMB) and probability of cost effectiveness was estimated for each comparator, and we conducted a Value of Information analysis to evaluate the scale and drivers of uncertainty. Results DIs were associated with lower NMB compared with medication and with group therapy, but greater NMB compared with non-therapeutic controls and with usual care. DIs that were supported by a clinician, an assistant or a lay person had higher delivery costs than purely patient-self-directed DIs, yielding a greater NMB when opportunity cost was above £3000/QALY. There was considerable uncertainty in the findings driven largely by uncertainty in the estimated treatment effects. The value of further research to establish the effectiveness of DIs for GAD was substantial, at least £12.9 billion. Conclusions The high uncertainty about these results does not allow for recommendations based on the cost effectiveness of DIs. However, the analysis highlights areas for future research, and demonstrates that apparent cost savings associated with DIs can be offset by reduced effectiveness. Supplementary Information The online version contains supplementary material available at 10.1007/s41669-021-00318-y.

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“…A systematic review of DMHI economic evaluations stated that 54 of 66 included articles did not explore the results beyond trial endpoints: "lack of longer-term modeling is likely to be due to, in part, the lack of reliable data about the long-term performance of DMHIs." 51 These data-driven limitations suggest longer-term comparative trial follow-ups are needed whenever possible with statistical methods as secondary options. 14,90,91 The VSE has suggested complications beyond what our analysis explores, with a new UK valuation study underway.…”

Section: Limitationsmentioning

confidence: 99%

“…50 Mental health services and interventions have evolved to deal with care demand; for example, stepped-care within Improving Access to Psychological Therapies (IAPT) services in England and use of low-intensity interventions such as Digital Mental Health Interventions (DMHIs), which require appropriate cost-effectiveness evidence. [51][52][53][54] For reimbursement agencies such as NICE, alternative preference-based measures can be rationalized based on aspects such as psychometric performance (4; p. 42), as suggested by Brazier and Deverill. 55 EQ-5D measures' psychometric results offer better support in common (eg, anxiety and depression) than severe (eg, schizophrenia and bipolar disorder) mental health disorders.…”

Section: Introductionmentioning

confidence: 99%

Estimating Cost-Effectiveness Using Alternative Preference-Based Scores and Within-Trial Methods: Exploring the Dynamics of the Quality-Adjusted Life-Year Using the EQ-5D 5-Level Version and Recovering Quality of Life Utility Index

et al. 2022

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Systematic Review and Critique of Methods for Economic Evaluation of Digital Mental Health Interventions

Cited by 18 publications

References 29 publications

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

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

Cost Effectiveness of Digital Interventions for Generalised Anxiety Disorder: A Model-Based Analysis

Estimating Cost-Effectiveness Using Alternative Preference-Based Scores and Within-Trial Methods: Exploring the Dynamics of the Quality-Adjusted Life-Year Using the EQ-5D 5-Level Version and Recovering Quality of Life Utility Index

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