A Framework for the Economic Evaluation of Digital Health Interventions

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