Economic evaluation of digital public health

Abstract

Digitalization has become relevant in the health sector since the development of the internet and smartphones. Accordingly, interest in digital healthcare technologies has been increasing. An area that still warrants further investigation is the use of digital technologies for disease prevention and health promotion at the population level. This has been associated with the term digital public health (DiPH). Prevention effectively mitigates the problem of potentially costly diseases; however, it is unclear whether there are specific points to consider in the evaluation of whether DiPH interventions are cost saving or, at least, cost effective. While health care significantly contributes to greenhouse gas emissions, it is unclear whether DiPH interventions are facilitating the reduction of or increase in greenhouse gases. Therefore, this thesis is guided by three research questions (RQs). RQ1 explores what should be considered in the economic evaluation of DiPH interventions. RQ2 reviews the health economic evidence on preventive DiPHs intervention using decision analytical modeling. RQ3 explores the evidence of CO2 emissions resulting from digitalization in the public health sector. These three RQs are investigated within four modules (M). The first two modules address specific issues related to the health economic evaluation of DiPH in book chapters on evaluation (M1) and sustainable financing of DiPH (M2). The issues include the need to account for high technology dynamics, for the potentially low marginal cost of covering additional users, or for identifying new ways of including carbon footprint into economic analysis. Given the importance of modeling in the economic assessment of DiPH, M3 presents the results of a systematized review of health economic evaluations using decision analytic modelling of DiPH. It shows, for example, that the types of preventive DiPH interventions that are covered by economic evaluations as well as their results and methodological quality are very heterogeneous. A systematic review (M4) of the calculations of virtual care (as one field of digitalization in healthcare) carbon footprints shows that digital technologies may sometimes help reduce carbon emissions. However, existing calculations lack methodological rigor. This thesis demonstrates that DiPH represent an important and partially specific area of health economic investigation. To exemplify how specific issues may be addressed, an exemplary economic evaluation of a preventive digital intervention is outlined which includes, for example, a DiPH-specific sensitivity analysis. Decision-makers should be able to add an environmental perspective to the established concepts of economic evaluation. Therefore, an extension of the CHEERS checklist to include carbon footprint into health economic evaluation is outlined, which needs to be further developed. Future research should consider this when designing economic evaluations of DiPH.