Department of Applied Health Research, University College London, London, United Kingdom.
J Med Internet Res. 2023 Nov 3;25:e45958. doi: 10.2196/45958.
Digital health interventions (DHIs) are defined as digital technologies such as digital health applications and information and communications technology systems (including SMS text messages) implemented to meet health objectives. DHIs implemented using various technologies, ranging from electronic medical records to videoconferencing systems and mobile apps, have experienced substantial growth and uptake in recent years. Although the clinical effectiveness of DHIs for children and adolescents has been relatively well studied, much less is known about the cost-effectiveness of these interventions.
This study aimed to systematically review economic evaluations of DHIs for pediatric and adolescent populations. This study also reviewed methodological issues specific to economic evaluations of DHIs to inform future research priorities.
We conducted a database search in PubMed from 2011 to 2021 using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. In total, 2 authors independently screened the titles and abstracts of the search results to identify studies eligible for full-text review. We generated a data abstraction procedure based on recommendations from the Panel on Cost-Effectiveness in Health and Medicine. The types of economic evaluations included in this review were cost-effectiveness analyses (costs per clinical effect), cost-benefit analyses (costs and effects expressed in monetary terms as net benefit), and cost-utility analyses (cost per quality-adjusted life year or disability-adjusted life year). Narrative analysis was used to synthesize the quantitative data because of heterogeneity across the studies. We extracted methodological issues related to study design, analysis framework, cost and outcome measurement, and methodological assumptions regarding the health economic evaluation.
We included 22 articles assessing the cost-effectiveness of DHI interventions for children and adolescents. Most articles (14/22, 64%) evaluated interventions delivered through web-based portals or SMS text messaging, most frequently within the health care specialties of mental health and maternal, newborn, and child health. In 82% (18/22) of the studies, DHIs were found to be cost-effective or cost saving compared with the nondigital standard of care. The key drivers of cost-effectiveness included population coverage, cost components, intervention effect size and scale-up, and study perspective. The most frequently identified methodological challenges were related to study design (17/22, 77%), costing (11/22, 50%), and economic modeling (9/22, 41%).
This is the first systematic review of economic evaluations of DHIs targeting pediatric and adolescent populations. We found that most DHIs (18/22, 82%) for children and adolescents were cost-effective or cost saving compared with the nondigital standard of care. In addition, this review identified key methodological challenges directly related to the conduct of economic evaluations of DHIs and highlighted areas where further methodological research is required to address these challenges. These included the need for measurement of user involvement and indirect effects of DHIs and the development of children-specific, generic quality-of-life outcomes.
数字健康干预（DHI）被定义为为满足健康目标而实施的数字技术，如数字健康应用程序和信息通信技术系统（包括短信文本消息）。近年来，使用从电子病历到视频会议系统和移动应用程序等各种技术的 DHI 经历了大幅增长和采用。尽管 DHI 对儿童和青少年的临床效果已经得到了相对较好的研究，但对于这些干预措施的成本效益知之甚少。
本研究旨在系统地回顾针对儿科和青少年人群的 DHI 的经济评估。本研究还回顾了 DHI 经济评估的具体方法问题，以为未来的研究重点提供信息。
我们按照 PRISMA（系统评价和荟萃分析的首选报告项目）检查表在 PubMed 数据库中进行了 2011 年至 2021 年的检索。共有 2 位作者独立筛选了检索结果的标题和摘要，以确定有资格进行全文审查的研究。我们根据卫生保健中的成本效益评估小组的建议生成了数据提取程序。本综述中纳入的经济评估类型包括成本效益分析（每临床效果的成本）、成本效益分析（以货币表示的成本和效果，即净效益）和成本效用分析（每质量调整生命年或残疾调整生命年的成本）。由于研究之间存在异质性，因此使用叙述性分析来综合定量数据。我们提取了与研究设计、分析框架、成本和结果测量以及健康经济评估的方法学假设相关的方法学问题。
我们纳入了 22 篇评估儿童和青少年 DHI 干预成本效益的文章。大多数文章（22 篇中的 14 篇，64%）评估了通过基于网络的门户或短信文本消息传递的干预措施，最常涉及心理健康和孕产妇、新生儿和儿童健康等医疗保健专业领域。在 82%（22 篇中的 18 篇）的研究中，与非数字标准护理相比，DHIs 被发现具有成本效益或成本节约。成本效益的关键驱动因素包括人口覆盖范围、成本组成部分、干预效果大小和扩展以及研究视角。最常被确定的方法学挑战与研究设计（22 篇中的 17 篇，77%）、成本计算（22 篇中的 11 篇，50%）和经济建模（22 篇中的 9 篇，41%）直接相关。
这是对针对儿科和青少年人群的 DHI 经济评估的首次系统评价。我们发现，与非数字标准护理相比，大多数针对儿童和青少年的 DHI（22 篇中的 18 篇，82%）具有成本效益或成本节约。此外，本综述确定了与 DHI 经济评估直接相关的关键方法学挑战，并强调了需要进一步进行方法学研究以解决这些挑战的领域。其中包括需要衡量用户参与度和 DHI 的间接影响，以及开发针对儿童的特定、通用的生活质量结果。
