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

Willems, Ruben; Annemans, Lieven; Siopis, George; Moschonis, George; Vedanthan, Rajesh; Jung, Jenny; Kwasnicka, Dominika; Oldenburg, Brian; d’Antonio, Claudia; Girolami, Sandro; Agapidaki, Eirini; Manios, Yannis; Verhaeghe, Nick; Usheva, Natalya; Iotova, Violeta; Triantafyllidis, Andreas; Votis, Konstantinos; Toti, Florian; Makrilakis, Konstantinos; Seghieri, Chiara; Moreno, Luis; Dupont, Sabine; Lewis, Leo; Djokic, Djordje; Skouteris, Helen

doi:10.26181/24986466.v1

1316664_Willems,R_2023.pdf (1.24 MB)

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

journal contribution

posted on 2024-01-11, 23:30 authored by Ruben Willems, Lieven Annemans, George SiopisGeorge Siopis, George MoschonisGeorge Moschonis, Rajesh Vedanthan, Jenny Jung, Dominika Kwasnicka, Brian OldenburgBrian Oldenburg, Claudia d’Antonio, Sandro Girolami, Eirini Agapidaki, Yannis Manios, Nick Verhaeghe, Natalya Usheva, Violeta Iotova, Andreas Triantafyllidis, Konstantinos Votis, Florian Toti, Konstantinos Makrilakis, Chiara Seghieri, Luis Moreno, Sabine Dupont, Leo Lewis, Djordje Djokic, Helen Skouteris

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).

Funding

The DigiCare4You study has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 945246. G.S., G.M., D.K. and B.O. received funding from the National Health and Medical Research Council (NHMRC) of Australia, as part of the NHMRC European Union Collaborative Research Grant Scheme, under the agreement with the NHMRC ID APP2007006. R.V. declares receipt by New York University Grossman School of Medicine of a DigiCare4You funding subaward.

History

Publication Date

2023-08-18

Journal

npj Digital Medicine

Volume

6

Issue

1

Article Number

150

Pagination

13p.

Publisher

Springer Nature

ISSN

2398-6352

Rights Statement

© The Author(s) 2023. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit: http://creativecommons.org/licenses/by/4.0/