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Digital symptom checkers (SCs) are increasingly used to support early symptom recognition and care-seeking, yet evidence on their cost-effectiveness remains limited. We conducted an economic evaluation of a digital SC for endometriosis, a prevalent but underdiagnosed condition, as a case study. We developed a Markov decision process model to compare the digital SC with the standard of care from a societal perspective. Over a 40-year horizon, the digital SC reduced diagnostic delay by 4.36 years, generated 0.049 quality-adjusted life years (QALYs) per person, saved $5196.22 in costs, and produced an incremental net monetary benefit (INMB) of $10,089.00 at a $100,000/QALY threshold. Probabilistic sensitivity analysis confirmed the robustness of these findings, with an INMB of $12,398.92 (95% CI: $11,893.11–$12,904.72). Scenario analyses showed that the SC remained cost-effective under a wide range of assumptions, with the greatest value realized when sensitivity and specificity were ≥0.7, compliance exceeded 45%, and a time horizon of at least 10 years. This study provides the first economic evaluation of a digital SC for endometriosis and illustrates when and how digital SCs can deliver value to patients and health systems.
PURPOSE: A number of measures have been proposed to evaluate meaningful within-person change in the Oxford Hip and Oxford Knee scores (OHS and OKS), however there is evidence of lower baseline scores being associated with higher change scores, that is, these instruments potentially demonstrate baseline dependency. The study aim was to identify and quantify the impact of baseline dependency for the OHS and OKS.
PATIENTS & METHODS: The data were collated from the National Health Service in England including the OHS, OKS, EQ-5D-3L and a global transition item (GTI). Change scores, including the minimally important change (MIC) were derived and categorised by the GTI and baseline scores for the OHS and OKS. Baseline dependency was evaluated using different baseline categories (OHS/OKS, EQ-5D quartiles and split-item method).
RESULTS: A total of 387,524 records were extracted. Although the overall MIC were in-line with previous research, the results showed these measures varied by pre-operative scores. Baseline dependency was present irrespective of the method employed to categorise change scores.
CONCLUSIONS: The MICs for both the OHS and OKS show distinct baseline dependencies. The use of a single MIC for either instrument is unlikely to capture the full range of meaningful change experienced by individual patients and therefore has implications for the interpretation of interventional outcomes with these instruments. A multifaceted approach involving multiple sources of patient-relevant measures is recommended to provide more robust measures for the evaluation of patient outcomes and healthcare services.
INTRODUCTION: Incorporating environmental sustainability into health technology assessment (HTA) is increasingly important for aligning with government targets, healthcare policies, and healthcare professional bodies endorsing the use of more sustainable health technologies, while maintaining clinical effectiveness and value for money. Although proposals exist to include environmental criteria in HTA, methodological development in this area remains limited. This study explored stakeholder perspectives on useful methods, frameworks and challenges for assessing environmental outcomes in HTA.
METHODS: Semi-structured interviews were conducted with eight stakeholders including HTA decision makers, industry representatives, sustainability professionals, and academics from different jurisdictions to ensure diverse views and cross-setting applicability. Data were analysed thematically to identify opportunities, barriers and facilitators for methodological development.
RESULTS: Stakeholders broadly supported integrating environmental outcomes into HTA, with carbon footprint highlighted as a key measurable and decision-relevant indicator. Environmental life cycle assessment (eLCA) was considered useful for quantifying emissions and identifying hotspots, but barriers included limited environmental data, lack of methodological consensus on scope and boundaries, and resource and expertise constraints. Broader environmental outcomes, such as impacts on resource use, biodiversity, and health, were also seen as important where evidence is available. Suggested approaches included carbon costing within economic evaluation, multi-criteria decision analysis (MCDA), expert consensus, and weighting of highly polluting technologies to address trade-offs. Stakeholders emphasised the need to understand societal preferences for environmental gains, including willingness to pay or trade-off health benefits.
CONCLUSIONS: This novel research provides the first qualitative insights into multidisciplinary stakeholder views on environmental sustainability in HTA, identifying both opportunities and challenges for methodological innovation and policy development.
BACKGROUND: The existing intravenous systemic anticancer therapy (SACT) pathway in pharmacies is operationally inefficient. Manual, paper-based workflows render the system prone to human error, and the need for time-consuming manual verification diverts pharmacy staff time. The introduction of an automated workflow solution for the intravenous SACT pathway could optimize treatment timeliness and improve oncological outcomes for patients, aligning with the National Health Service Long Term Plan for improved cancer care.
OBJECTIVE: This observational analysis aimed to assess the change in time, cost, and errors following the implementation of the Becton Dickinson (BD) Cato Pharmacy system in an aseptic unit producing intravenous SACT at Watford General Hospital.
METHODS: Data on compounding process times were collected manually by pharmacy staff before and after the implementation of the intravenous compounding software (BD Cato). The data were analyzed to estimate annual time savings, opportunity cost savings, and error reduction.
RESULTS: The intravenous compounding software produced a time saving of 18 (SD 9) minutes per drug, equating to 1034 hours saved per year (1034/2591, 39.9% reduction). If this time were repurposed to producing more intravenous SACT, Watford General Hospital could increase production by 66% (2298/3482) annually (2298 additional intravenous SACT). This represents an average cost saving of £11.29 (£1=US $1.273) per drug, equating to an annual opportunity cost saving of £39,246. The intravenous compounding software also decreased observed errors by 86% (43/50), a reduction of 43 errors over 2 months (approximately 258 fewer errors annually). Staff also preferred the intravenous compounding software to the manual system.
CONCLUSIONS: Implementing intravenous compounding software can save time, reduce costs, and lower errors in intravenous SACT preparation. This could improve timely treatment access for patients with cancer.
Health technology assessment (HTA) must increasingly incorporate environmental sustainability (ES) to ensure digital health technologies (DHTs) deliver true value for both population and planetary health. Existing HTA frameworks inadequately capture the upstream and downstream environmental implications of DHTs, overlooking critical factors such as energy consumption, data storage, water usage and electronic waste. Using a few examples on telehealth platforms, electronic health records and artificial intelligence (AI) driven diagnostic tools, we illustrate how these technologies can reduce carbon emissions and other pollutants by limiting patient travel and optimizing resource use. We review current HTA frameworks, identify ongoing initiatives, and highlight gaps and challenges in integrating ES into value assessment. Traditional HTA models provide limited guidance for incorporating broad environmental factors, risking underestimation of DHTs’ environmental impacts and potentially undermining health systems’ net-zero commitments by 2050. To address these issues, in this commentary, we propose for targeted investment in frameworks, streamlined environmental data collection, and stronger cross-sector collaboration. Systemic inclusion of ES can reduce inequalities, support ethical supply chains and incentivize developers to design lower-impact technologies, positioning HTA as a driver of sustainable digital health innovation. By embedding environmental metrics, health systems can better balance clinical benefits, economic efficiency and ecological responsibility, thereby advancing both human and planetary health.
BACKGROUND: Infections represent the most serious complication associated with cardiac implantable electronic devices (CIEDs). This can result in prolonged hospital stays, high morbidity and mortality, and a significant economic burden for healthcare systems.
OBJECTIVES: This study aimed to evaluate the cost-effectiveness of the TYRX absorbable antibacterial envelope for CIED infection prevention from the Spanish Healthcare System perspective.
METHODS: A decision tree model with a lifetime horizon was developed to compare standard antibiotic prophylaxis with its combination with TYRX, regardless of infection risk. The model incorporated infection incidence, mortality, and utility values up to 36 months, derived from REINFORCE, AdaptResponse, and WRAP-IT studies. Unit costs (2025 euros) included prevention strategies and infection management. Lifetime costs and quality-adjusted life-years (QALYs) were assigned to survivors beyond 36 months. The incremental cost-effectiveness ratio (ICER) was reported by CIED and weighted by implant distribution (permanent pacemaker [PPM, 76.5%], implantable cardioverter-defibrillator [ICD, 15.2%], cardiac resynchronization therapy with defibrillator [CRT-D, 5.4%], and pacemaker [CRT-P, 2.9%]). A subgroup analysis was performed in high-risk patients (PADIT≥7), modifying infection rates based on PADIT risk stratification, along with sensitivity analyses. Model inputs were validated by an expert panel.
RESULTS: TYRX was the dominant strategy (more effective and less costly) for CRT-D and ICD recipients and cost-effective for those receiving PPM (€17 740/QALY) or CRT-P (€14 647/QALY), considering a willingness-to-pay threshold of €25 000/QALY. Across the spectrum of CIEDs, the ICER was €11 709/QALY. TYRX remained cost-effective in 77% of sensitivity analysis simulations. In high-risk patients, TYRX was dominant for all CIEDs.
DISCUSSION: This study is believed to be the first economic evaluation of TYRX in Spain and provides novel evidence in a broad, unselected population. Previous cost-effectiveness analyses conducted across different healthcare systems have consistently shown that TYRX is cost-effective in patients at elevated risk for device-related infections. Although the populations and healthcare settings differ, our findings are consistent with this body of evidence.
CONCLUSIONS: TYRX represents a dominant strategy for infection prevention for CRT-D and ICD and is cost-effective for PPM and CRT-P, based on Spain’s willingness to pay.
