A Framework for the Economic Evaluation of Digital Health Interventions

Numerous digital health interventions have been piloted in response to the health care challenges low- and middle-income countries face. Because the opportunity cost of investing in digital health interventions can be large, countries must make choices about which interventions to scale up. To make good investment decisions about digital health interventions, there is a need to define and establish their value, and to use economic evaluation to make informed decisions, however DHIs present methodological challenges for economic evaluation. To address these challenges, this paper first creates a ‘gap map’ of digital evidence which reveals a dearth of economic evaluation evidence about digital health interventions; this lack can limit decisions on policy, programming, and appropriate scale-up of digital health interventions. To advance work in this field, this paper then develops an economic evaluation framework that can be used when determining the economic value of digital health interventions. Such a standardized approach, alongside guidance to assist the conduct and use of economic evidence, can improve decision making and investments in DHI under constrained health budgets. The resulting digital health intervention economic evaluation framework consists of 5 steps: (1) determine the context, (2) determine the intervention type, (3) establish the level of complexity, (4) set the analytic principles, and (5) represent the value proposition. Users of the framework should attempt to adhere to its steps and principles, but where this is not feasible or appropriate, they should provide justification for the methodological choice. The framework should facilitate methodological transparency, thereby improving the overall usefulness of economic evaluations of digital health interventions.