Background

Health technology assessment (HTA) for digital health interventions can be used as an important policy reform that can assist policymakers in tackling inequities and inefficiencies by improving the way health resources are allocated towards impactful, cost-effective, appropriate, and feasible interventions. As health systems increasingly make investment decisions in digital health technologies (DHTs)—and these can play a key role in addressing health inequities, expanding health systems coverage and universal healthcare by improving health system performance—it is important that DHTs are specifically and comprehensively assessed through the HTA process.
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Challenges

DHTs are increasingly present in the field of HTA. However, studies have identified several missing elements. In many cases, the missing elements in HTA are related to key assessment components, especially ethical, including the exclusion of certain patient populations, and social and organizational implications. Although DHT research is increasing, it does not cover all the content recommended for a DHT-specific and comprehensive HTA. The inability to conduct such an HTA may lead to health services making suboptimal investment decisions. The assessment may not be comprehensive enough to ensure that health disparities are minimized. Furthermore, the use of typical HTA criteria and evaluation being adopted for DHTs may create a precedent that skews decisions and may become difficult to revert.

Desired state of HTA and digital health, leading to health equity:

Health disparities are evident across continents, within countries, and inside communities, and the population faces inequitable access to patient-centered healthcare. It is crucial to explore and implement advanced solutions to the provision of patient-centered care, with an aim to reduce pressures on the healthcare system simultaneously. The use of DHTs is one of these solutions. 

Economic evaluation of the benefits of a new technology or treatment cannot be based only on health gain versus monetary expenditure required, but also on its effect on the quality of life of the treated population and the strengthening of health systems. DHTs have the potential to transform healthcare. It must be done in a way that is equitable, sustainable, rooted in ethical principles, and leading to safe and reliable care. As expressed in the WHO’s Global Digital Health Strategy 2020-2025, to achieve this vision, digital health “should be developed with principles of transparency, accessibility, scalability, replicability, interoperability, privacy, security and confidentiality.” 

The assessment of DHTs is crucial to bring more high-quality, value-based care to the market and to patients. There is a need for a holistic and more appropriate framework to assess the value of DHTs. HTA has the potential to provide a systematic approach to evaluate the properties, effects, and costs of all kinds of health technologies or interventions while considering equity issues and health impact. 

The use of DHTs is a viable option to increase equitable access to quality, patient-centered care and simultaneously reduce pressures on the healthcare system. Recommendations include emphasizing stakeholder engagement, strengthening digital literacy, supporting the improvement of DHT infrastructure, increasing cross-sectorial collaboration, strengthening governance of cybersecurity, and leading the way in DHT uptake.

Opportunities:

Pharmaceutical companies, health insurance companies, technology companies, foundations, patient advocacy groups, and ministries of health have a reach that cuts across the entire health ecosystem and patient journey, and thus, the opportunity and responsibility to ensure HTAs are formulated to maximize DHTs’ role in increasing equity and enabling quality patient-centered care. PW can help assess the right space and strategies to occupy to play a role in this process. 

References:

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