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  • Evidence Syntheses and Value Assessment of Digital Health Interventions

    Evidence Syntheses and Value Assessment of Digital Health Interventions

    Digital health interventions (DHIs) are changing the care delivery and experience. However, the speed of innovation often overtakes the ability to assess what truly works. Therefore, evidence syntheses and value assessments are crucial in helping researchers, clinicians, and policymakers identify solutions that deliver meaningful impact.(1, 2)

    Evidence from systematic reviews has frequently shown DHIs to exhibit strong usability, safety, acceptability, and favourable clinical advantages, especially when rooted in user-centred design and supplemented by human interaction. However, evidence for long-term efficacy, cost-effectiveness, and scalable real-world application continues to be varied. This inconsistency highlights the need for context-aware assessments, which also focus on user experience, equity, and workflow integration as much as measured outcomes.(1, 3, 4)

    For clarity, researchers are increasingly turning to umbrella reviews, rapid assessments, and scoping reviews, and evidence gap maps (EGMs) to synthesize what is known and identify where major gaps persist.(5) These syntheses also underscore persisting challenges, including heterogeneous study designs, variable outcome measures, and diverse intervention components, which restrict comparability across studies. Consequently, modern assessments emphasize systematized reporting, transparent risk-of-bias evaluations, and alignment with the complete patient journey.(4, 6)

    Value assessment is central to digital health decision-making. Beyond clinical outcomes, value includes user-friendliness, cost-effectiveness, equity, and system-level advantages. Although frameworks categorize these components, they are not uniformly applied in empirical research, which warrants practical measures and economic models that depict real-world conditions.(4, 6)

    The success of DHIs also depends on engagement and adherence; however, engagement doesn’t always guarantee better outcomes.(6, 7) Effective solutions must alleviate burden, fit seamlessly into daily routines, and sustain user motivation, elements that are increasingly being captured in contemporary evidence syntheses.(4-6)

    Furthermore, economic evaluation of DHIs adds another layer of complexity. Digital tools are associated with unique costs, including development, maintenance, interoperability, cybersecurity; while also including benefits that grow over time. Standardized methods, scenario analyses, and sensitivity testing are crucial for generating credible, policy-relevant insights.(8, 9)

    Implementing DHIs is a crucial bridge between evidence and practice. EGMs and implementation frameworks help pinpoint where robust research exists and where more work is needed to strengthen adoption, reliability, and sustainability.(4, 5) Quality, safety, and equity are equally non-negotiable components. Systematic reviews increasingly highlight privacy and security risks and explore differential effects across sociodemographic groups to ensure digital tools do not increase disparities. Transparent reporting and robust appraisal improve trust that guide responsible decision-making.(1, 2)

    Finally, consistent, meaningful assessments will help stakeholders recognize high-value digital health solutions while facilitating safe, equitable, and impactful innovation. With evolving methods, evidence will continue to shape, not just validate, the future of digital health.

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    References

    1. Merino M, Del Barrio J, Nuño R, Errea M. Value-based digital health: A systematic literature review of the value elements of digital health care. Digit Health. 2024; 10:20552076241277438.
    2. Liu S, Ma J, Sun M, et al. Mapping the Landscape of Digital Health Intervention Strategies: 25-Year Synthesis. J Med Internet Res. 2025; 27:e59027.
    3. Rauschenberg C, Schick A, Hirjak D, et al. Evidence Synthesis of Digital Interventions to Mitigate the Negative Impact of the COVID-19 Pandemic on Public Mental Health: Rapid Meta-review. J Med Internet Res. 2021; 23(3):e23365.
    4. Milne-Ives M, Homer SR, Andrade J, Meinert E. Mapping the Process of Engagement With Digital Health Interventions: A Cross-Case Synthesis. Mayo Clin Proc Innov Qual Outcomes. 2025; 9(3):100625.
    5. Campbell, F., Tricco, A.C., Munn, Z. et al. Mapping reviews, scoping reviews, and evidence and gap maps (EGMs): the same but different – the “Big Picture” review family. Syst Rev. 2023; 12:45.
    6. Iwakura M, Ozeki C, Jung S, et al. An umbrella review of efficacy of digital health interventions for workers. npj Digit. Med. 2025; 8:207.
    7. Sun S, Simonsson O, McGarvey S, et al. Mobile phone interventions to improve health outcomes among patients with chronic diseases: an umbrella review and evidence synthesis from 34 meta-analyses. The Lancet Digital Health. 2024; 6(11):e857-e870.
    8. Gomes M, Murray E, Raftery J. Economic Evaluation of Digital Health Interventions: Methodological Issues and Recommendations for Practice. Pharmacoeconomics. 2022; 40(4):367-378.
    9. Wilkinson T, Wang M, Friedman J, Görgens M. A Framework for the Economic Evaluation. Policy Research Working Paper; World Bank Group. 2023. Accessed online at: https://documents1.worldbank.org/curated/en/099446504122313917/pdf/IDU0f639726d0f11404a3509af8054677649dcd6.pdf

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  • Assessing the Value of Preventive Health Interventions

    Assessing the Value of Preventive Health Interventions

    QALY

    The growing challenges of increasing healthcare costs and changing population needs are making the significance of preventive health interventions more evident. However, even with their ability to transform health outcomes and lower long-term expenses, prevention strategies are often underestimated in traditional assessment frameworks.[1]

    Conventional assessments have largely relied on metrics including the incremental cost-effectiveness ratio (ICER) and quality-adjusted life years (QALYs) to validate an intervention’s benefits relative to its cost. While these assessments offer a structured guidance on comparing health interventions, they often fail to evaluate the bigger, long-term, and societal impact of prevention.[2-4]

    Evolving research and policy debates highlight the need to reform prevention not just as a cost to be controlled, but also as a valuable investment to achieve significant returns.[2, 3] Preventive health interventions can improve workforce productivity, decrease healthcare utilization, and enhance quality of life; all of which depict the benefits extending well beyond direct clinical outcomes. By justifying the social and economic burden mitigated through prevention, new assessment frameworks aim to indicate the full extent of value these interventions offer.[2-4]

    Preventive measures often overlap with demanding social elements of health, such as education, income, and housing. They also often involve stakeholders across different sectors. Intrinsically, capturing the true value of preventive interventions necessitates incorporating different data sources and accounting for non-health outcomes, such as social unity, decreased inequality, and economic flexibility. This difficulty highlights the incompetence of restrictive, health-centred models in fully demonstrating the societal returns of preventive interventions.[2, 3]

    To address these challenges, health economic experts highlight the importance of implementing comprehensive analytical methods, such as cost-benefit analysis (CBA), return on investment (ROI), and societal impact evaluations. These methods facilitate the measurement of both health and non-health financial benefits, giving policymakers a precise understanding of the impact of the preventive action in terms of overall wellbeing. Notably, these methods also help associate health investments with larger goals, including economic growth and social equity, redrafting healthcare costs as contributors to long-term prosperity.[2]

    In conclusion, a structured value assessment framework for preventive interventions must balance analytical precision with real-world applicability. It should integrate long-term and cross-sectoral impact, and involve different types and sources of evidence to comprehensively represent the priorities of the populations it seeks to serve. By going beyond a narrow focus of cost-effectiveness and adopting an all-encompassing concept of value, health systems can better summarize the real influence of preventive interventions. This broader focus can facilitate smarter, more reasonable investments that encourage overall well-being and promote sustainable growth.

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    References

    1. Sturmberg JP, Bircher J. Better and fulfilling healthcare at lower costs: The need to manage health systems as complex adaptive systems. F1000Res. 2019; 5(8):789.
    2. Mazzucato, M, Roy V. Rethinking value in health innovation: from mystifications towards prescriptions. Journal of Economic Policy Reform. 2018; 22(2):101-119.
    3. OECD (2024), Rethinking Health System Performance Assessment: A Renewed Framework. [Accessed 03 Jun 2025]. Available at: https://www.oecd.org/en/publications/rethinking-health-system-performance-assessment_107182c8-en/full-report.html
    4. Ostwald DA. Rethinking value assessment of preventive health interventions – A Health ROI Assessor framework. May 2024. [Accessed 03 Jun 2025]. Available at: https://www.ispor.org/docs/default-source/intl2024/20240428-dennis-ostwald-rethinking-value-assessment-of-preventive-health-interventions-ispor-atlanta.pdf?sfvrsn=77256ba_0

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  • Whole Health Value Assessment

    Whole Health Value Assessment
    Whole Health Value Assessment

    The focus of healthcare assessments has conventionally been more on clinical and cost-efficiency of interventions. However, this tapered focus might overlook the aspects that contribute to meaningful health outcomes among individuals. The emerging concept of “Whole Health” highlights a wider, person-centred perspective of health that goes beyond physical well-being to include behavioural, emotional, social, economic, and spiritual aspects. “Whole Health” signifies a rising consensus that value in healthcare must be taken in the context of people’s lived experiences, not only through clinical parameters, but through their ability to live well.[1, 2]
    This paradigm shift reflects in ISPOR’s Strategic Plan 2030,[3] that puts forth the concept of accessible, affordable, and more comprehensive healthcare that defines and delivers value.[3, 4] Inspired by the WHO’s renewed perspective on health as “a resource for everyday life, not the objective of living,”[5] ISPOR too identifies health as a comprehensive resource to advance HEOR. Consequently, assessments of health interventions must integrate a broader and more demonstrative belief of health aligning with the “Whole Health” paradigm.[2]
    In reality, Whole Health value assessment integrates five basic elements: it is “people-centred, comprehensive and holistic, upstream focused, equitable and accountable, and grounded in well-being.”[2] These factors define a framework where individuals, families, communities, and healthcare systems strive together to create ‘value’. An intervention’s efficacy is not reviewed only in clinical parameters but by its ability to enhance a person’s daily life, cultivate emotional and spiritual flexibility, and minimize socioeconomic challenges. Notably, the concept of “Whole Health” promotes the incorporation of clinical, behavioural, and social care systems, all working collectively to focus on the overall health demands.[2]
    The ”Whole Health” concept also encourages a more interdependent approach for generating evidence, including patient-reported outcomes (PROs), real-world data (RWD), and context-based narratives that depict different definitions of health as experienced by individuals and communities.[6] Therefore, the true health value can be assessed with components like therapeutic relationship, the patient’s personhood, and the clinician’s humanity. In Whole Health, well-being is not just the absence of disease, but the presence of a goal of contently living life and functionality, combining both hedonic (happiness-driven) and eudaimonic (meaning-driven) aspects of health.[2]
    Whole Health value assessments have significant impact on HEOR in that they broaden the scope of what is evaluated, how it is measured, and whose viewpoints are prioritized.[2] By aligning with ISPOR’s strategic goals,[3] Whole Health value assessments lead more rigorous, relevant, and unbiased evaluations that represent the complexities of ever-changing modern healthcare. Whole Health also encourages stakeholders to redefine healthcare success not only by measuring disease control or economic savings, but by evaluating the quality of life lived.[1, 2, 6]
    Whole Health value assessments encourage to perceive ‘value’ not only in the intervention, but also in its significance to what individuals sincerely need and care about. By doing so, they provide a more effective and more justified basis for healthcare decision-making globally.

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    References

    1. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Committee on Transforming Health Care to Create Whole Health: Strategies to Assess, Scale, and Spread the Whole Person Approach to Health; Meisnere M, South-Paul J, Krist AH, editors. Achieving Whole Health: A New Approach for Veterans and the Nation. Washington (DC): National Academies Press (US); 2023 Feb 15. 2, Defining Whole Health. Available from: https://www.ncbi.nlm.nih.gov/books/NBK591719/
    2. Pizzi LT, Abbott RM, Onukwugha E. Taking Health Economics and Outcomes Research Forward: Expanding the Definition of Value to Include Whole Health. Value Health. 2025; 28(5):702-704.
    3. ISPOR. Strategic Plan 2030. 2024. Available online at: https://www.ispor.org/heor-resources/news-top/news/view/2024/07/29/ispor-announces-new-strategic-plan-2030
    4. Walker J. ISPOR’s new strategic plan underscores importance of accessible, effective, efficient, and affordable global health care. Becaris Publishing. 2024. Available online at: https://becarispublishing.com/digital-content/blog-post/ispor-s-new-strategic-plan-underscores-importance-accessible-effective-efficient-and
    5. WHO. Health Promotion. Available online at: https://www.who.int/teams/health-promotion/enhanced-wellbeing/first-global-conference
    6. Westritch K. “Whole Health” Value Assessment: Universal Survey Framework for Integrating Patient Experience Data in Health Technology Assessment. National Pharmaceutical Council. 2024. Available online at: https://www.ispor.org/docs/default-source/intl2024/ispor-whole-health-value-assessment-slidesmerged.pdf?sfvrsn=4a5a66ac_0

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