Economic Evaluation Associated With Clinical-Grade Mobile App–Based Digital Therapeutic Interventions: Systematic Review

Abstract

Background Digital therapeutics (DTx), a class of software-based clinical interventions, are promising new technologies that can potentially prevent, manage, or treat a spectrum of medical disorders and diseases as well as deliver unprecedented portability for patients and scalability for health care providers. Their adoption and implementation were accelerated by the need for remote care during the COVID-19 pandemic, and awareness about their utility has rapidly grown among providers, payers, and regulators. Despite this, relatively little is known about the capacity of DTx to provide economic value in care. Objective This study aimed to systematically review and summarize the published evidence regarding the cost-effectiveness of clinical-grade mobile app–based DTx and explore the factors affecting such evaluations. Methods A systematic review of economic evaluations of clinical-grade mobile app–based DTx was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Major electronic databases, including PubMed, Cochrane Library, and Web of Science, were searched for eligible studies published from inception to October 28, 2022. Two independent reviewers evaluated the eligibility of all the retrieved articles for inclusion in the review. Methodological quality and risk of bias were assessed for each included study. Results A total of 18 studies were included in this review. Of the 18 studies, 7 (39%) were nonrandomized study–based economic evaluations, 6 (33%) were model-based evaluations, and 5 (28%) were randomized clinical trial–based evaluations. The DTx intervention subject to assessment was found to be cost-effective in 12 (67%) studies, cost saving in 5 (28%) studies, and cost-effective in 1 (6%) study in only 1 of the 3 countries where it was being deployed in the final study. Qualitative deficiencies in methodology and substantial potential for bias, including risks of performance bias and selection bias in participant recruitment, were identified in several included studies. Conclusions This systematic review supports the thesis that DTx interventions offer potential economic benefits. However, DTx economic analyses conducted to date exhibit important methodological shortcomings that must be addressed in future evaluations to reduce the uncertainty surrounding the widespread adoption of DTx interventions. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42022358616; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022358616

N-of-1 medicine

“…Importantly, innovation and adoption are substantially different objectives, which require an expansive range of disciplines, policy advances and other factors to achieve the level of behavioural change needed to drive changes in practice at the clinical and user stages, not to mention the validated economics and value outcomes needed at the reimbursement and subsidy stages. [ 92 93 ]…”

REHABS: An Innovative and User-Friendly Device for Rehabilitation

“…However, portable medical devices for telemonitoring can cause inconvenience for the patient, for example, when they get in the way of daily activities or malfunctions occur that cannot be solved easily [ 30 ]. Multiple home rehabilitation devices are available and implemented; however, some technologies face limitations in the application, availability, as well as cost and preparation of appropriate rehabilitation therapist to support the rehabilitation process [ 31 ]. Arntz et al in [ 32 ] recently demonstrated that feasible and effective approaches are needed to implement functional home-based recovery, which meet patients’ demands and ensure adequate levels of treatment.…”