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Cost-effectiveness of digital tools for behavior change interventions among people with chronic diseases: systematic review
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.ORCID iD: 0000-0002-5177-0756
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. School of Public Health and Community Medicine, Institution of Medicine, University of Gothenburg, Göteborg, Sweden.ORCID iD: 0000-0003-0556-1483
School of Public Health and Community Medicine, Institution of Medicine, University of Gothenburg, Göteborg, Sweden.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.ORCID iD: 0000-0002-1617-6102
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2023 (English)In: Interactive Journal of Medical Research, E-ISSN 1929-073X, Vol. 12, article id e42396Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: Chronic diseases, including cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, and cerebrovascular diseases, contribute to the most significant disease burden worldwide, negatively impacting patients and their family members. People with chronic diseases have common modifiable behavioral risk factors, including smoking, alcohol overconsumption, and unhealthy diets. Digital-based interventions for promoting and sustaining behavioral changes have flourished in recent years, although evidence of the cost-effectiveness of such interventions remains inconclusive.

OBJECTIVE: In this study, we aimed to investigate the cost-effectiveness of digital health interventions for behavioral changes among people with chronic diseases.

METHODS: This systematic review evaluated published studies focused on the economic evaluation of digital tools for behavioral change among adults with chronic diseases. We followed the Population, Intervention, Comparator, and Outcomes framework to retrieve relevant publications from 4 databases: PubMed, CINAHL, Scopus, and Web of Science. We used the Joanna Briggs Institute's criteria for economic evaluation and randomized controlled trials to assess the risk of bias in the studies. Two researchers independently screened, assessed the quality, and extracted data from the studies selected for the review.

RESULTS: In total, 20 studies published between 2003 and 2021 fulfilled our inclusion criteria. All the studies were conducted in high-income countries. These studies used telephones, SMS text messaging, mobile health apps, and websites as digital tools for behavior change communication. Most digital tools for interventions focused on diet and nutrition (17/20, 85%) and physical activity (16/20, 80%), and a few focused on smoking and tobacco control (8/20, 40%), alcohol reduction (6/20, 30%), and reduction of salt intake (3/20, 15%). Most studies (17/20, 85%) used the health care payer perspective for economic analysis, and only 15% (3/20) used the societal perspective. Only 45% (9/20) of studies conducted a full economic evaluation. Most studies (7/20, 35%) based on full economic evaluation and 30% (6/20) of studies based on partial economic evaluation found digital health interventions to be cost-effective and cost-saving. Most studies had short follow-ups and failed to include proper indicators for economic evaluation, such as quality-adjusted life-years, disability-adjusted life-years, lack of discounting, and sensitivity analysis.

CONCLUSIONS: Digital health interventions for behavioral change among people with chronic diseases are cost-effective in high-income settings and can therefore be scaled up. Similar evidence from low- and middle-income countries based on properly designed studies for cost-effectiveness evaluation is urgently required. A full economic evaluation is needed to provide robust evidence for the cost-effectiveness of digital health interventions and their potential for scaling up in a wider population. Future studies should follow the National Institute for Health and Clinical Excellence recommendations to take a societal perspective, apply discounting, address parameter uncertainty, and apply a lifelong time horizon.

Place, publisher, year, edition, pages
JMIR Publications , 2023. Vol. 12, article id e42396
Keywords [en]
behavior, chronic diseases, cost-effectiveness, digital tools, lifestyle, mobile phone, systematic review
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Public health
Identifiers
URN: urn:nbn:se:umu:diva-205443DOI: 10.2196/42396ISI: 000976564200003PubMedID: 36795470OAI: oai:DiVA.org:umu-205443DiVA, id: diva2:1741535
Part of project
STAR-C: Sustainable behaviour change for health supported by person-Tailored, Adaptive, Risk-aware digital Coaching in a social context , Forte, Swedish Research Council for Health, Working Life and Welfare
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-01461Available from: 2023-03-06 Created: 2023-03-06 Last updated: 2023-09-05Bibliographically approved

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Ng, NawiWennberg, PatrikSahlen, Klas-Göran

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