The first evaluation by the newly formed Peterson Health Technology Institute (PHTI) was published in March upon digital health technologies that support diabetes management. The aim of the PHTI is to provide an independent evaluation using evidence-based research upon the clinical & economic benefit of emerging digital health technologies, along with highlighting the effect on health equity, privacy & security.[1]
The method in which the evidence, upon these digital health technologies, will be evaluated is reported in the ‘ICER-PHTI Assessment Framework for Digital Health’[2] which was co-created with the Institute for Clinical and Economic Review (ICER). A multi-stakeholder approach is used to contribute into the evaluation including independent evaluation partners (e.g. ICER), clinical expert, patient perspectives via interviews & focus groups, digital health technology companies input & other partners (e.g. consulting firms).
Type 2 diabetes places a high management burden on the individual and their caregivers due to the regular monitoring and lifestyle changes required to prevent serious clinical complications.[3] Given more people are developing the condition at younger ages (below 45 years) there has been a rise in the prevalence of the condition which has led to innovation advances being given a global priority. Due to this, diabetes has seen numerous digital health technologies launched, aiming to support remote monitoring of blood glucose levels, behaviour & lifestyle modifications and nutritional ketosis.
The PHTI evaluation concluded that “Digital diabetes management solutions in the remote patient monitoring and behaviour and lifestyle modification categories do not deliver meaningful clinical benefits, and they increase healthcare spending relative to usual care. Nutritional ketosis solutions hold promise for diabetes remission.”[4] The evaluation also highlighted that the current digital health technologies were not addressing health disparities as they are generally provided to less complex patient populations and further focus on innovation should be around underserved populations. Additional primary research exploring the burden of diabetes on these underserved individuals could highlight the need for digital health technologies and outline the value clinically and economically.
Ultimately the PHTI evaluations framework is focused around the clinical impact of the digital health technology and the economic impact upon the perspective of the healthcare system compared to standard of care. As we see economic evaluations perspectives widening to incorporate quality of life[5], societal costs[6]and patient preferences[7] a more holistic assessment of these digital health technologies may be warranted to truly understand the value of these products.
A wider evaluation that not only incorporates the clinical impact but also the impact upon quality of life should be considered as digital health technologies have the potential to have substantial impact on people’s lives. In addition, as the perspective of the evaluation is focused on the provider standpoint it does not incorporate direct-non medical & indirect costs reductions that these digital health technologies may contribute to. One such benefit that could be explored further is the productivity benefits these solutions can provide by reducing absenteeism & presenteeism. A patient and public involvement & engagement (PPIE) study with users of the digital health technology and with people who do not use the technology could provide these further insights into the impact into quality of life & productivity.
The report highlights that “patients reported varying degrees of engagement”[4], understanding to what extent engagement & preference varies is of key importance to truly define the value of any heath intervention. By characterizing the patient preferences this assists in making health care decisions and is an essential element of evidence-based practice. Overall, the patient preference upon these digital health technologies should be more integrated into the review of these technologies as it is an important component to enabling higher adherence and thus avoiding serious clinical complications.
In conclusion the PHTI recommended that sufficient evidence generation is critical to support emerging digital health technologies and capital should be set aside to invest in evidence on the clinical and economic benefits to providers and patients.[4] Plus that researchers must find the right balance of speed & rigor to demonstrate the value compared to the standard of care. We look forward to reading the next assessment upon virtual musculoskeletal solutions and how the evidence required for digital health develops in the future.
DHT.health can support digital health companies by providing rapid and affordable real world evidence, health economic, preference and outcomes research to demonstrate the value of their solution. If this is something that you wish to understand further, please contact us using the link below.
References:
1. Peterson Health Technology Institute. (2024). Retrieved from https://phti.com
2. ICER-PHTI Assessment Framework (2023). Retrieved from https://icer.org/assessment/icer-phti-assessment-framework-fordigital-health-technologies/
3. CDC “Type 2 Diabetes” (2023). Retrieved from https://www.cdc.gov/diabetes/basics/type2.html#:~:text=Type%202%20diabetes%20most%20often,adults%20are%20also%20developing%20it
4. Digital Diabetes Management Solution Health Technology Assessment. PHTI. (2024) Retrieved from https://phti.com/assessment/digital-diabetes-management-tools/
5. Torgerson D, Raftery J. Economics notes: measuring outcomes in economic evaluations. BMJ. 1999 May 22;318(7195):1413. doi: 10.1136/bmj.318.7195.1413
6. Peña-Longobardo LM, Rodríguez-Sánchez B, Oliva-Moreno J, Aranda-Reneo I, López-Bastida J. How relevant are social costs in economic evaluations? The case of Alzheimer's disease. Eur J Health Econ. 2019 Nov;20(8):1207-1236. doi: 10.1007/s10198-019-01087-6.
7. Brazier JE, Dixon S, Ratcliffe J. The role of patient preferences in cost-effectiveness analysis: a conflict of values?. Pharmacoeconomics. 2009;27(9):705-712. doi:10.2165/11314840-000000000-00000