Cost-effectiveness of digital health in primary care: a systematic review

Background Digital health has rapidly expanded, accelerated by the COVID-19 pandemic, and is widely used for consultations, disease management, and efficiency improvements in primary care. While it is considered clinically effective and potentially cost-effective, evidence on economic impact remains limited. Previous reviews have been condition-specific, highlighting the need for a systematic review focused on cost-effectiveness of digital health within primary care. Objectives The aim of this systematic review was to summarize and investigate the cost-effectiveness of digital health among adult primary care patients. Methods A systematic literature search was conducted using the PICO framework. Studies were included if they involved adult primary care patients (≥18 years), evaluated digital health interventions versus usual care, and reported cost‑effectiveness based on economic evaluations. PubMed, Scopus, and Health Business Elite were searched in January 2025. An updated search was conducted in September 2026. Results were reported in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Methodological quality was assessed using the Joanna Briggs Institute Checklist for Economic Evaluations. A narrative synthesis was performed. Results The initial search identified 4,091 records and resulted in 47 included studies. The updated search in September 2026 identified an additional 658 records, of which seven additional studies met the eligibility criteria, resulting in a total of 54 included studies. Most were trial‑based full economic evaluations focusing on digital interventions for depression and anxiety, adopting a healthcare perspective. Overall, digital health interventions were frequently associated with favourable economic outcomes, although results varied by intervention, population, economic evaluation method, and time horizon. Discussion This review is innovative in its focus on the cost‑effectiveness of digital health interventions in primary care. Unlike previous reviews, it systematically synthesises trial‑ and model‑based economic evaluations. The review advances the field by clarifying the economic evidence base and has practical implications for decision‑makers considering the implementation of digital health in primary care. The review is limited by rapidly evolving digital health terminology, the exclusion of grey literature, and substantial methodological heterogeneity between trial‑based and model‑based economic evaluations. Potential selection bias related to digital literacy may limit generalisability. Conclusions Digital health in primary care demonstrated favourable economic outcomes across a broad range of clinical areas, with the majority of studies reporting cost-effective results. However, despite this positive pattern, methodological heterogeneity limits comparability between studies. Greater standardization of economic evaluation methods and reporting is therefore needed to strengthen the evidence base and support implementation decisions. Trial Registration PROSPERO registration no. CRD42025644904; [https://www.crd.york.ac.uk/PROSPERO/view/CRD42025644904].