A Value Framework to Assess Patient-Facing Digital Health Technologies That Aim to Improve Chronic Disease Management: A Delphi Approach

Background Digital health technologies (DHTs) can optimise healthcare costs and improve quality and efficiency of care. However, the fast-paced rate of innovation and varying evidence standards can make it difficult for decision-makers to assess these technologies in an efficient and evidence-based manner. Objectives We sought to develop a comprehensive framework to assess the value of novel patient-facing DHTs used to manage chronic diseases by eliciting stakeholder value preferences. Methods Literature review and primary data collection from a three-round web-Delphi exercise was utilised. 79 participants from five stakeholder groups (patients, physicians, industry, decision-makers and influencers) and three countries (USA, UK and Germany) took part. Likert scale data was statistically analysed to determine inter-group differences in both country and stakeholder groups, stability of results, and overall consensus. Results The resulting co-created framework comprised 33 stable indicators with consensus from quantitative value judgements across domains: health inequalities, data rights and governance, technical and security, economic characteristics, clinical characteristics and user preferences. Lack of stakeholder consensus was observed on the importance of value-based care models, optimizing resources for sustainable systems, and stakeholder involvement in DHT design, development, and implementation; however, this was due to high rates of neutrality and not negative judgements. Supply-side actors and academic experts were the most unstable stakeholder groups. Conclusion Stakeholder value judgements revealed a need for a coordinated regulatory and HTA policy response that updates laws to meet technological innovations, offers a pragmatic approach to evidence standards to assess DHTs and involves stakeholders to understand and meet their needs.