Paying for Digital Health Interventions - What Evidence is Needed?

ABSTRACT

Digital health has accelerated, in part, due to the recent COVID-19 pandemic in terms of both implementation and acceptability. However, while digitalization in healthcare brings an opportunity to improve the quality of care, this creates a need for sustainability through funding of these technologies by healthcare payers. Traditional innovations such as pharmaceuticals are rigorously evaluated by health technology assessment (HTA) bodies in many countries to advise payers on how scarce funds can be efficiently distributed. The aim of this study was to review the HTA evidence frameworks being applied by HTA bodies or payers for the evaluation of digital health interventions. We reviewed recent literature and the websites of the leading payer and HTA bodies to understand the frameworks which have been used for the evaluation of digital health innovations. We found that 6 frameworks directly addressed digital health technologies for the purposes of pricing and reimbursement. Building on previous work, we reviewed the context and evidence domains of each framework. The evidence requirements of the included frameworks were diverse, and their domains extended the European Network for Health Technology Assessment (EUnetHTA) Core HTA Model. Our research concluded that while some frameworks exist, they require additional refinement to ensure that the level of evidence is commensurate with the technology being assessed and that relevant stakeholders are included to more holistically assess the outcomes produced. Developers of digital health technologies need to be aware of the evidence requirements by payers or HTA bodies, which differ from HTA requirements for traditional health technologies and may represent additional hurdle before entering publicly financed healthcare markets.