McNamee Paul, Murray Elizabeth, Kelly Michael P, Bojke Laura, Chilcott Jim, Fischer Alastair, West Robert, Yardley Lucy
Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, United Kingdom.
Am J Prev Med. 2016 Nov;51(5):852-860. doi: 10.1016/j.amepre.2016.05.007.
This paper introduces and discusses key issues in the economic evaluation of digital health interventions. The purpose is to stimulate debate so that existing economic techniques may be refined or new methods developed. The paper does not seek to provide definitive guidance on appropriate methods of economic analysis for digital health interventions. This paper describes existing guides and analytic frameworks that have been suggested for the economic evaluation of healthcare interventions. Using selected examples of digital health interventions, it assesses how well existing guides and frameworks align to digital health interventions. It shows that digital health interventions may be best characterized as complex interventions in complex systems. Key features of complexity relate to intervention complexity, outcome complexity, and causal pathway complexity, with much of this driven by iterative intervention development over time and uncertainty regarding likely reach of the interventions among the relevant population. These characteristics imply that more-complex methods of economic evaluation are likely to be better able to capture fully the impact of the intervention on costs and benefits over the appropriate time horizon. This complexity includes wider measurement of costs and benefits, and a modeling framework that is able to capture dynamic interactions among the intervention, the population of interest, and the environment. The authors recommend that future research should develop and apply more-flexible modeling techniques to allow better prediction of the interdependency between interventions and important environmental influences.
本文介绍并讨论了数字健康干预措施经济评估中的关键问题。目的是激发讨论，以便对现有的经济技术进行完善或开发新的方法。本文并非旨在为数字健康干预措施的经济分析适当方法提供权威性指导。本文描述了已针对医疗保健干预措施经济评估提出的现有指南和分析框架。通过数字健康干预措施的选定示例，评估现有指南和框架与数字健康干预措施的契合程度。结果表明，数字健康干预措施最好被描述为复杂系统中的复杂干预措施。复杂性的关键特征涉及干预复杂性、结果复杂性和因果路径复杂性，其中大部分是由随着时间推移的迭代干预开发以及干预措施在相关人群中可能覆盖范围的不确定性所驱动的。这些特征意味着，更复杂的经济评估方法可能更有能力在适当的时间范围内充分捕捉干预措施对成本和效益的影响。这种复杂性包括对成本和效益的更广泛衡量，以及一个能够捕捉干预措施、目标人群和环境之间动态相互作用的建模框架。作者建议未来的研究应开发并应用更灵活的建模技术，以便更好地预测干预措施与重要环境影响之间的相互依存关系。
