Center for Health Care Improvement, St. Olav Hospital, Trondheim University Hospital, 3250, Torgarden, 7006, Trondheim, Norway.
Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
Pharmacoeconomics. 2024 Jun;42(6):663-678. doi: 10.1007/s40273-024-01366-y. Epub 2024 Mar 26.
The rate of development and complexity of digital health interventions (DHIs) in recent years has to some extent outpaced the methodological development in economic evaluation and costing. Particularly, the choice of cost components included in intervention or program costs of DHIs have received scant attention. The aim of this study was to build a literature-informed checklist of program cost components of DHIs. The checklist was next tested by applying it to an empirical case, Mamma Mia, a DHI developed to prevent perinatal depression.
A scoping review with a structured literature search identified peer-reviewed literature from 2010 to 2022 that offers guidance on program costs of DHIs. Relevant guidance was summarized and extracted elements were organized into categories of main cost components and their associated activities following the standard three-step approach, that is, activities, resource use and unit costs.
Of the 3448 records reviewed, 12 studies met the criteria for data extraction. The main cost categories identified were development, research, maintenance, implementation and health personnel involvement (HPI). Costs are largely considered to be context-specific, may decrease as the DHI matures and vary with number of users. The five categories and their associated activities constitute the checklist. This was applied to estimate program costs per user for Mamma Mia Self-Guided and Blended, the latter including additional guidance from public health nurses during standard maternal check-ups. Excluding research, the program cost per mother was more than double for Blended compared with Self-Guided (€140.5 versus €56.6, 2022 Euros) due to increased implementation and HPI costs. Including research increased the program costs to €190.8 and €106.9, respectively. One-way sensitivity analyses showed sensitivity to changes in number of users, lifespan of the app, salaries and license fee.
The checklist can help increase transparency of cost calculation and improve future comparison across studies.
近年来，数字健康干预措施（DHIs）的发展速度和复杂程度在一定程度上超过了经济评估和成本核算的方法发展。特别是，DHIs 的干预或项目成本中包含的成本组成部分的选择受到了很少的关注。本研究旨在构建一个基于文献的 DHI 项目成本组成部分清单。该清单随后通过应用于一个实证案例 Mamma Mia 进行了测试，Mamma Mia 是一种开发来预防围产期抑郁的 DHI。
通过结构化文献检索进行的范围综述确定了 2010 年至 2022 年提供有关 DHIs 项目成本指南的同行评议文献。对相关指南进行了总结，并根据标准的三步法（即活动、资源使用和单位成本）将提取的要素组织成主要成本组成部分及其相关活动类别。
在审查的 3448 条记录中，有 12 项研究符合数据提取标准。确定的主要成本类别是开发、研究、维护、实施和卫生人员参与（HPI）。成本在很大程度上被认为是特定于上下文的，随着 DHI 的成熟，成本可能会降低，并且随用户数量的变化而变化。这五个类别及其相关活动构成了清单。该清单用于估算 Mamma Mia 自助和混合模式的每个用户的项目成本，后者包括在标准产妇检查期间由公共卫生护士提供的额外指导。不包括研究，混合模式的每个母亲的项目成本比自助模式高出一倍以上（2022 年欧元分别为 140.5 欧元和 56.6 欧元），原因是实施和 HPI 成本增加。包括研究将项目成本分别增加到 190.8 欧元和 106.9 欧元。单因素敏感性分析表明，对用户数量、应用程序的使用寿命、工资和许可证费用的变化敏感。
该清单可以帮助提高成本计算的透明度，并提高未来研究之间的比较。
