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Systematic Review and Critique of Methods for Economic Evaluation of Digital Mental Health Interventions


  • Dina Jankovic

    (The University of York, Alcuin College)

  • Laura Bojke

    (The University of York, Alcuin College)

  • David Marshall

    (University of York)

  • Pedro Saramago Goncalves

    (The University of York, Alcuin College)

  • Rachel Churchill

    (University of York)

  • Hollie Melton

    (University of York)

  • Sally Brabyn

    (University of York)

  • Lina Gega

    (University of York)


Objectives Investment in digital interventions for mental health conditions is growing rapidly, offering the potential to elevate systems that are currently overstretched. Despite a growing literature on economic evaluation of digital mental health interventions (DMHIs), including several systematic reviews, there is no conclusive evidence regarding their cost-effectiveness. This paper reviews the methodology used to determine their cost-effectiveness and assesses whether this meets the requirements for decision-making. In doing so we consider the challenges specific to the economic evaluation of DMHIs, and identify where consensus and possible further research is warranted. Methods A systematic review was conducted to identify all economic evaluations of DMHIs published between 1997 and December 2018. The searches included databases of published and unpublished research, reference lists and citations of all included studies, forward citations on all identified protocols and conference abstracts, and contacting authors researchers in the field. The identified studies were critiqued against a published set of requirements for decision-making in healthcare, identifying methodological challenges and areas where consensus is required. Results The review identified 67 papers evaluating DMHIs. The majority of the evaluations were conducted alongside trials, failing to capture all relevant available evidence and comparators, and long-term impact of mental health disorders. The identified interventions are complex and heterogeneous. As a result, there are a number of challenges specific to their evaluation, including estimation of all costs and outcomes, conditional on analysis viewpoint, and identification of relevant comparators. A taxonomy for DMHIs may be required to inform what interventions can reasonably be pooled and compared. Conclusions This study represents the first attempt to understand the appropriateness of the methodologies used to evaluate the value for money of DMHIs, helping work towards consensus and methods’ harmonisation on these complex interventions.

Suggested Citation

  • Dina Jankovic & Laura Bojke & David Marshall & Pedro Saramago Goncalves & Rachel Churchill & Hollie Melton & Sally Brabyn & Lina Gega, 2021. "Systematic Review and Critique of Methods for Economic Evaluation of Digital Mental Health Interventions," Applied Health Economics and Health Policy, Springer, vol. 19(1), pages 17-27, January.
  • Handle: RePEc:spr:aphecp:v:19:y:2021:i:1:d:10.1007_s40258-020-00607-3
    DOI: 10.1007/s40258-020-00607-3

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    References listed on IDEAS

    1. Carla Guerriero & John Cairns & Ian Roberts & Anthony Rodgers & Robyn Whittaker & Caroline Free, 2013. "The cost-effectiveness of smoking cessation support delivered by mobile phone text messaging: Txt2stop," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(5), pages 789-797, October.
    2. Mark J. Sculpher & Karl Claxton & Mike Drummond & Chris McCabe, 2006. "Whither trial‐based economic evaluation for health care decision making?," Health Economics, John Wiley & Sons, Ltd., vol. 15(7), pages 677-687, July.
    3. Shefali Kumar & Megan Jones Bell & Jessie L Juusola, 2018. "Mobile and traditional cognitive behavioral therapy programs for generalized anxiety disorder: A cost-effectiveness analysis," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-14, January.
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    Blog mentions

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    1. Chris Sampson’s journal round-up for 1st February 2021
      by Chris Sampson in The Academic Health Economists' Blog on 2021-02-01 12:00:03


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    Cited by:

    1. Dina Jankovic & Pedro Saramago Goncalves & Lina Gega & David Marshall & Kath Wright & Meena Hafidh & Rachel Churchill & Laura Bojke, 2022. "Cost Effectiveness of Digital Interventions for Generalised Anxiety Disorder: A Model-Based Analysis," PharmacoEconomics - Open, Springer, vol. 6(3), pages 377-388, May.
    2. Manuel Gomes & Elizabeth Murray & James Raftery, 2022. "Economic Evaluation of Digital Health Interventions: Methodological Issues and Recommendations for Practice," PharmacoEconomics, Springer, vol. 40(4), pages 367-378, April.

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