Cost-Effectiveness of Digital Health Interventions for Asthma or COPD: Systematic Review

Autores da FMUP

• Bernardo Manuel De Sousa Pinto

  Autor

Participantes de fora da FMUP

• Ferreira, Marta Alexandra Martins
• dos Santos, Adalberto Fernandes
• Taborda-Barata, Luis

Unidades de investigação

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• Medicina da Comunidade, Informação e Decisão em Saúde

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

Objective: Digital interventions such as remote monitoring of symptoms and physiological measurements have the potential to reduce the economic burden of asthma and chronic obstructive pulmonary disease (COPD) but their cost-effectiveness remains unclear. This systematic review of randomised controlled trials (RCT) aims to assess whether digital health interventions can be cost-effective in these patients. Design: Systematic review of RCTs. Study quality was assessed using RoB2 tool. Data Sources: Systematic search in three databases: PubMed, Scopus and Web of Science. Eligibility Criteria: Studies were eligible if they were RCTs with health economic evaluations assessing participants with asthma and/or COPD and comparing a digital health intervention to standard of care. Results: We included 35 RCTs, of which 21 were related to COPD, 13 to asthma and one to both diseases. Overall, studies assessed four categories of digital health interventions: (i) Electronic patient diaries (n = 4), (ii) real-time monitoring (n = 19), (iii) teleconsultations (n = 6) and (iv) others (n = 6). Eleven studies performed a full economic evaluation analysis, while 24 studies performed a partial economic analysis. Most studies involving real-time monitoring or teleconsultations presented economic results in favour of digital health interventions (indicating them to be cost-effective or less expensive than the standard of care). Mixed results were obtained for electronic patient diaries. In the studies that conducted a full economic analysis, the incremental cost-effectiveness ratio (ICER) ranged from 3530,93<euro>/QALY and 286,369,28<euro>/QALY. In the studies that conducted a partial economic analysis, the cost differences between the intervention group and the control group ranged from 0,12<euro> and 85,217,86<euro>. Half studies with low risk of bias concluded that the intervention was economically favourable. Conclusion: Although costs varied based on intervention type, follow-up period and country, most studies report digital health interventions to be affordable or associated with decreased costs.

Keywords

• asthma; COPD; cost-effectiveness; costs; cost-utility; telemedicine