Table 2 Differences in the content of steps for conducting economic and financial evaluations of mHealth solutions

Define the objective

Identify the research questions, define the purpose of the work, audience for and intended use of information;

Objective should clearly state the perspective, population, locations, time horizon, and for full economic evaluation, the comparator and outcomes selected

Define the perspective or viewpoint from which the analysis is undertaken

Societal perspective is considered gold standard; collection of all perspectives allows for scenarios to be presented for individual perspectives (program, user, payer, health systems)

Program perspective^a most common

MEEP: Societal perspective [31]

ISPOR: Program perspective

Program perspective

Define the intervention

Target population size and characteristics,

Target disease(s),

Delivery sites,

Technology and architecture systems,

Activities required to develop, start-up and maintain implementation

Define the comparator against which costs and effects are measured

Minimally the following comparators should be assessed:

Interventions/program or mix currently available to the population

The most cost-effective alternative

‘do nothing’ analysis representing non-interventional care for the population [31]

Not applicable; single program

Minimally the following comparators should be assessed:

Interventions/program or mix currently available to the population

The most cost-effective alternative

‘do nothing’ analysis representing non-interventional care for the population

Not applicable; single program

Define the time horizon, including the time frame (period in which intervention is applied) and analytic time horizon (period for which costs and consequences are considered) [57]

Trial based evaluations Time frame aligned with program duration

Model based Defined by analyst should be of sufficient length to capture all costs and effects relevant to the decision problem

Time horizon of relevance to the budget holder; 1 to 5 years is most common but may vary by country/organization and therefore reasons for choice should be stated

Identify, measure, and value consequences

Measure of health outcome specific to the decision problem; should capture positive and negative effects on length of life and quality of life; should be generalizable across disease states [31]

CBAs may include non-health outcomes

Many studies may include synthesis estimates if effects on multiple target groups are anticipated

Since results may be sensitive to outcome, it may be useful to test several

Not applicable

Measure of outputs/health outcome specific to the decision problem; should capture positive and negative effects on length of life and quality of life; should be generalizable across disease states

Impact on health outcomes may be forecasted

Identify, measure, and value costs

Use of economic costs or approximations

Primary vs secondary data source

Data reported on expected resource use and costs of delivery to the target population(s)

Overall costs of interventions reported as well as costs of resource inputs

Categorization of costs: capital vs. recurrent, fixed vs. semi variable vs. variable costs

Annualization of capital and fixed costs over the period of implementation [31]

Discounting/constant prices

Inflation to base year

Converting costs into USD

For some analyses, converting to international dollars with purchasing power parities may also be indicated

Use of financial costs most common

Data reported on expected resource use and costs of delivery to the target population(s)

Overall costs of interventions reported as well as costs of resource inputs

Categorization of costs: capital vs. recurrent, fixed vs. variable

Annualization of capital and fixed costs over the period of implementation [31]

Adjusting estimated unit costs to the year of reported costs

Converting costs into USD

Use of direct costs (exclude overheads) [50]

Categorization of costs: Capital vs. recurrent, fixed vs. variable

Annualization of capital and fixed costs over the period of implementation [31] (if applicable)

No discounting [50]

Converting costs into USD [31]

Use of financial costs/actual acquisition cost of intervention

Data reported on expected resource use and costs of delivery to the target population(s)

Overall costs of interventions reported as well as costs of resource inputs

Categorization of costs: capital vs. recurrent, fixed vs. variable

Annualization of capital and fixed costs over the period of implementation [31]

Adjusting estimated unit costs to the year of reported costs

Converting costs into USD

Modeling and analysis

Use of decision-analytic model

Decision tree

Markov model (individual-level/microsimulation or cohort),

Discrete-event simulation

Net benefit regression

Extended cost-effectiveness analyses

Compartmental model

Estimation of costs for alternatives by year of implementation;

Analysis of key drivers of costs

Estimation of costs for single program by year of implementation;

Analysis of key drivers of costs

Estimation of costs for single program by year of implementation;

Division of cost by key outcome measures;

Analysis of key drivers of costs

One of 3 analytic frameworks: BIA cost calculator, Condition-specific cohort, or Individual simulation model [50]

Validation of computing framework and input data

Estimation of costs for alternatives by year of implementation;

Analysis of key drivers of costs

Application of TCO model or other simple excel based spreadsheet

Account for uncertainty

Recommended assessment of 3 types of uncertainty:

Structural uncertainty introduced by the assumptions made

Source of values for parameter estimates

Parameter precision—uncertainty around the mean health and cost inputs in the model

Gold standard is to conduct Probabilistic sensitivity analysis. This enables the uncertainty associated with parameters to be assessed simultaneously and incorporated in the results of the model

Threshold, univariate and multi-variate sensitivity analyses are most commonly used

Parameter uncertainty in the input values used

Structural uncertainty introduced by the assumptions made in framing the BIA

Threshold, univariate and multi-variate sensitivity analyses are most commonly used

Adjustment for optimization bias and risk exposure

Interpret and present results

Study parameters

Summary of incremental costs and consequences

Cost effectiveness plane

Tornado diagram/threshold analyses

Cost effectiveness acceptability curve

Characterizing heterogeneity

Discuss generalizability

Describe underlying assumptions

Summary of unit costs

Summary of aggregate and sub-category costs by activity and level of the health system for each year of implementation for each alternative

Summary of unit costs

Summary of aggregate and sub-category costs by activity and level of the health system for each year of implementation

Design of the BIA reported

Disaggregated and annualized BIA which demonstrates implications on Government and social insurance budgets; Households and out of pocket expenses; Third-party payers; and External donors [50]

Both budget period resource use and costs should be presented

Summary of unit costs

Summary of aggregate and sub-category costs by activity and level of the health system for each year of implementation

Ensure quality in reporting your evidence

Drummond Checklist [25] and/or CHEERS checklist screening [58]; MEEP principals for Economic Evaluation [31]

Reporting standards not available; select components of the CHEERS checklist can be applied

ISPOR principles of good practice [50]

Donor specific reporting standards