Key result
Smartphone application, text-messaging, and website-based interventions are cost-effective for T2DM and hypertension, with a median incremental cost-utility ratio of €3840/QALY and no substantial differences between delivery modes.
Why the study?
The cost-effectiveness of text-messaging, smartphone application, and website digital health interventions for adults with or at risk of T2DM and/or hypertension has not been synthesized and compared.
Are digital health interventions (text-messaging, smartphone applications, and websites) cost-effective in adults with or at risk of T2DM and/or hypertension?
Systematic Review (n=14)
Are digital health interventions (text-messaging, smartphone applications, and websites) cost-effective in adults with or at risk of T2DM and/or hypertension?
Effect estimate: median €3840/QALY
Digital health interventions via smartphone apps, text-messaging, and websites are cost-effective for adults with or at risk of T2DM, but not consistently for hypertension.
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).
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Willems et al. (2023) conducted a systematic review in Type 2 diabetes mellitus or hypertension (n=14). Digital health interventions (text messaging, smartphone applications, websites) vs. Care as usual or enhanced care as usual was evaluated on Incremental cost-utility ratio (ICUR) (median €3840/QALY). Smartphone application, text-messaging, and website-based interventions are cost-effective for T2DM and hypertension, with a median incremental cost-utility ratio of €3840/QALY and no substantial differences between delivery modes.
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