Analytical Frameworks and Outcome Measures in Economic Evaluations of Digital Health Interventions: A Methodological Systematic Review

BACKGROUND

Digital health interventions (DHIs) can improve the provision of health care services. To fully account for their effects in economic evaluations, traditional methods based on measuring health-related quality of life may not be appropriate, as nonhealth and process outcomes are likely to be relevant too.

PURPOSE

This systematic review identifies, assesses, and synthesizes the arguments on the analytical frameworks and outcome measures used in the economic evaluations of DHIs. The results informed recommendations for future economic evaluations.

DATA SOURCES

We ran searches on multiple databases, complemented by gray literature and backward and forward citation searches.

STUDY SELECTION

We included records containing theoretical and empirical arguments associated with the use of analytical frameworks and outcome measures for economic evaluations of DHIs. Following title/abstract and full-text screening, our final analysis included 15 studies.

DATA EXTRACTION

The arguments we extracted related to analytical frameworks (14 studies), generic outcome measures (5 studies), techniques used to elicit utility values (3 studies), and disease-specific outcome measures and instruments to collect health states data (both from 2 studies).

DATA SYNTHESIS

Rather than assessing the quality of the studies, we critically assessed and synthesized the extracted arguments. Building on this synthesis, we developed a 3-stage set of recommendations in which we encourage the use of impact matrices and analyses of equity impacts to integrate traditional economic evaluation methods.

LIMITATIONS

Our review and recommendations explored but not fully covered other potentially important aspects of economic evaluations that were outside our scope.

CONCLUSIONS

This is the first systematic review that summarizes the arguments on how the effects of DHIs could be measured in economic evaluations. Our recommendations will help design future economic evaluations.

HIGHLIGHTS

Using traditional outcome measures based on health-related quality of life (such as the quality-adjusted life-year) may not be appropriate in economic evaluations of digital health interventions, which are likely to trigger nonhealth and process outcomes.This is the first systematic review to investigate how the effects of digital health interventions could be measured in economic evaluations.We extracted and synthesized different arguments from the literature, outlining advantages and disadvantages associated with different methods used to measure the effects of digital health interventions.We propose a methodological set of recommendations in which 1) we suggest that researchers consider the use of impact matrices and cost-consequence analysis, 2) we discuss the suitability of analytical frameworks and outcome measures available in economic evaluations, and 3) we highlight the need for analyses of equity impacts.

Is it time to revisit the AO classification of fractures of the distal radius? Inter- and intra-observer reliability of the AO classification

We conducted an observational radiographic study to determine the inter- and intra-observer reliability of the AO classification of fractures of the distal radius. Plain posteroanterior and lateral radiographs of 456 patients with an acute fracture of the distal radius were classified by a consultant orthopaedic hand specialist and two specialist trainees, and the k coefficient for the inter- and intra-observer reliability of the type, group and subgroup classification was calculated. Only the type of fracture (A, B or C) was found to provide substantial intra-observer reliability (k type 0.65). The inclusion of 'group' and 'subgroup' into the classification reduced the inter-observer reliability to fair (kgroup 0.29, ksubgroup = 0.28) and the intra-observer reliability to moderate (kgroup 0.53, ksubgroup 0.49). Disagreement was found to arise between specific subgroups, which may be amenable to clarification.

Laryngeal pseudosulcus as a predictor of laryngopharyngeal reflux

OBJECTIVES/HYPOTHESIS

Laryngeal pseudosulcus is an accurate prognostic indicator of laryngopharyngeal reflux (LPR) disease.

STUDY DESIGN

Prospective study of 20 consecutive patients with laryngeal pseudosulcus. Pseudosulcus is infraglottic laryngeal edema that is thought to be secondary to LPR. All patients were evaluated with dual-channel pH probe 24-hour monitoring to evaluate for the presence of laryngopharyngeal reflux.

METHODS

Twenty patients identified with laryngeal pseudosulcus on routine physical examination were included in the study. Each patient underwent a 24-hour dual-channel pH probe. The data were analyzed and compared with previously published normative data. The data included the total number of reflux episodes and the percentage of time the pH dropped below 4 at the proximal probe.

RESULTS

Eighteen of the 20 patients with laryngeal pseudosulcus were found to have LPR. The mean number of reflux episodes at the proximal probe was 29.4 (range, 3-82). The mean percentage of time the pH dropped below 4 was 1.15%. In the upright position the mean value was 1.59% and in the supine position it was 0.19%. This gives pseudosulcus a positive predictive value for LPR of 90%.

CONCLUSION

This study shows laryngeal pseudosulcus to be an accurate predictor of laryngopharyngeal reflux disease.