Health economic evaluation of digital nursing technologies : a review of methodological recommendations

Background: Health economic evaluation of digital nursing technologies (DNT) is important to provide information that helps avoid undesirable developments and implementations as well as increase the chances of success of developed applications. At the same time, studies and evidence on cost-effectiveness are still very rare in this field. Review studies in related technology areas such as telemedicine frequently criticise the quality and comparability of health economic evaluations conducted in this field. Based on a content analysis of methodological literature on the economic evaluation of innovative (digital) technologies in health and nursing, this article aims to identify specific challenges in this research area and offers recommendations on how to address these challenges to promote more sound health economic evaluations in the future. Methods: A rapid review was conducted, consisting of a systematic search in the Pubmed database as well as Google Scholar. In addition, the literature lists of the analysed texts were scoured for additional texts to be included. Methodological literature, single studies, and reviews were included. A total of 536 studies were screened, of which 29 were included in the full text analysis. Results: Based on the systematic content analysis of the studies under consideration, 10 specific methodological challenges are identified, and the methodological recommendations were examined for consideration. A particular focus was given to whether specific methodological approaches might be needed in the context of evaluating the efficiency of DNT. Conclusion: Many of the challenges identified for the health economic evaluations of digital nursing technologies are comparable to those of other complex health care interventions. The recommendations discussed can help to alleviate those challenges. Future research should focus on alternative approaches to assessing causality in different phases of technology development while maintaining high evidence standards. High-evidence economic assessment of technologies in nursing care should be carried out in routine use, especially if they are intended to be reimbursed by the social insurance.