Economic evaluations of digital health interventions : a bibliometric analysis and a review of methodological challenges

Background: Digital health interventions (DHI) have been identified as a tool that has the potential to meet the growing demand for healthcare, improve the efficiency and sustainability of healthcare, and increase the accessibility and quality of care. The adoption and use of DHI for healthcare was strongly encouraged during the COVID-19 pandemic, resulting in a sharp increase in the number of DHI-related publications. Objectives: The number of DHI's economic evaluations (EE) is significantly smaller, accounting for less than 5% of publications on DHI. However, they are essential for demonstrating DHI's cost-effectiveness relative to comparable healthcare interventions. Methods/Approach: We conduct a bibliometric analysis of publications on EE of DHI extracted from the Web of Science Core Collection. Results: We analyse 2,308 publications from 2005 to 2023 and present the most influential countries, organisations, journals, and publications along with the corresponding bibliometric networks to explore the existing literature on EE of DHI. Furthermore, we systematise concerns and methodological challenges surrounding the economic justification of DHI. Conclusions: This paper aims to build a knowledge base for future research to improve EE of DHI, given that only strong clinical and economic evidence can adequately inform resource allocation decisions and thereby encourage adoption of DHI.