Economic Evaluations of Digital Health Interventions for Patients With Heart Failure: Systematic Review (Preprint)

Abstract

BACKGROUND Background: Digital health interventions (DHIs) have shown promising results in enhancing the management of heart failure (HF). Although healthcare interventions are increasingly being delivered digitally with growing evidence on the potential cost-effectiveness of adopting them, there has been little effort to collate and to synthesise the findings OBJECTIVE Objective: The objective of this study was to systematically review the economic evaluations (EEs) that assess the adoption of DHIs in the management and treatment of HF. METHODS Methods: The databases, including PubMed, EBSCOhost, and Scopus were searched for full EEs in the relevant topic up to July 2023. Study characteristics, design (trials-based and model-based), input parameters, and main results were extracted from full-text articles. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement was used to appraise the reporting quality of each included study. RESULTS Results: Overall, 27 EEs were included in the review. The EEs were based on models (48%), trials (48%), or hybrid (4%). Devices evaluated included non-invasive remote monitoring (RM) devices e.g. home telemonitoring (HTM) using tablets or specific medical devices that enable transmission of physiological data, telephone support, mobile apps and wearables, RM follow-up in implantable medical devices, and video conferencing systems. Cost-utility analysis (CUA) was the most common analysis used, accounting for 22 studies (89%). Most studies were conducted in high-income countries, particularly European countries (59%) such as the United Kingdom and the Netherlands. Mobile apps and wearables, RM follow-up in implantable medical devices, and video conferencing strategies yielded cost-effective results or even emerged as dominant strategies. However, conflicting results were observed, particularly in non-invasive RM devices and telephone support. In 4 studies (14%), these DHIs were found to be less costly and more effective than the comparator i.e. dominant, while 9 studies (33%) reported them to be more costly but more effective with an incremental cost-effectiveness ratio (ICER) below the respective willingness-to-pay (WTP) thresholds, thus considered cost-effective. Additionally, in 3 studies (11%), they were either above the WTP threshold or more costly yet equally effective as the comparator, i.e. not cost-effective. Overall, studies were classified as good (74%), moderate (22%), and excellent (4%). CONCLUSIONS Conclusion: Despite the presence of conflicting results, the main findings indicated that overall, DHIs were more cost-effective than the non-DHIs alternatives.