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

Interuniversity Center of Health Economic Research (ICHER), department of Public Health and Primary Care, Ghent University, Ghent, Belgium. Ruben.Willems@ugent.be. Interuniversity Center of Health Economic Research (ICHER), department of Public Health and Primary Care, Ghent University, Ghent, Belgium. Department of Food, Nutrition and Dietetics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia. Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia. Department of Population Health, NYU Grossman School of Medicine, New York, USA. Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia. NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Baker Heart and Diabetes Institute, Melbourne, Australia. Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland. Meteda S.r.l., Roma, Italy. Ministry of Health, Athens, Greece. Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece. Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece.

NPJ digital medicine. 2023;(1):150
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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).

Methodological quality

Publication Type : Review

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