Meta-Analysis: Studies Usually Show DTx To Be Often Cost-Effective, Although Methodology Differs

As the makers of prescription digital therapeutics push to convince payers and providers of the value of their products, a new meta-analysis suggests such products are usually cost effective.

However, the report also serves as a call to action, urging investigators to be more careful to follow best practices when studying the value of the new class of therapies. The report was published in the Journal of Medical Internet Research.

Corresponding author Yoann Sapanel, M.Sc., of the National University of Singapore, and colleagues, said clinical evidence supporting the use of computer software to deliver personalized therapeutic interventions is mounting, but they said such evidence may not be enough to spark widespread availability of such technologies.

“There is currently limited consensus on whether these technologies are cost effective compared with traditional treatments,” they wrote. “Because cost effectiveness is an important consideration in payers’ reimbursement and pricing decisions, questions regarding the potential economic impact of DTx (digital therapeutics) merit exploration.”

The authors searched existing scientific databases to find cost-effectiveness studies for digital therapeutics published no later than October 28 of last year. Most of the resulting studies (10 of 18) were conducted in the United States. The remaining studies were conducted in Europe, Japan, Taiwan, or a combination of countries. The studies evaluated digital therapeutics designed to treat an array of diseases, including urinary incontinence, diabetes, opioid use disorder, and cardiovascular disease.

The perspectives of the economic evaluations used in the studies varied significantly. Two-thirds of the studies used economic analysis from the perspective of payers, while the remaining six studies looked at cost-efficacy from a societal perspective or both a payer and societal perspective. Most of the studies (10 of the 18) used a 6- or 12-month time horizon for their economic evaluation, but one study used a 10-year time horizon and two studies were based on lifetime use. The size of the intervention groups in the studies also varied widely.

Fourteen of the 18 studies included an assessment of the therapeutics’ impact on clinical outcomes, and 11 of those studies found the DTx improved outcomes compared to usual care. One study found it only improved outcomes in 1 of 3 countries studied, and two studies found no clinical benefit compared to usual care.

In terms of cost-efficacy, two-thirds of the digital therapeutics studied (12 of 18) were found to be cost effective, and 5 of the remaining 6 studies led to cost-savings. In the final study, the results were mixed depending on the country. When investigators stratified results based on the degree of economic analysis, they found 9 of the 10 studies that included a full economic evaluation found the therapeutic was cost-effective.

However, while Sapanel and colleagues said the published studies showed digital therapies can have a positive economic impact, they said their meta-analysis also exposed a number of issues that could limit the impact of the studies. They noted that the studies were all conducted in high-income countries, and most (12) were supported by industry funding. They also said there was variability in terms of the methodologies used in the studies, and in terms of adherence to best practices of economic analysis.

“In the future, DTx EE (economic evaluation) will need to adhere to local and international guidelines, use generalizable tools and metrics for enhanced comparability of the findings, and be both long-term focused and all-inclusive when factoring in value and cost,” they said. “Such efforts are crucial for minimizing providers’, payers’, and patients’ uncertainties surrounding the adoption of DTx interventions.”