Abstract
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Introduction
Innovative digital health technologies (DHTs) may present new aspects of value that are not appropriately accounted for in current health technology assessments. In discovering what value means in the context of DHTs, multi-stakeholder collaboration is essential.
Methods
A scoping literature review was conducted to identify current value assessment criteria and proposed methodologies across three health systems: United States of America, United Kingdom, and Germany. A Delphi exercise was conducted with stakeholders from the following groups: users, healthcare practitioners, decision-makers, supply-side actors, and influencers. Based on a review of assessment frameworks in the study countries and consultations with experts from each stakeholder group, researchers proposed value constructs in five domains: health inequalities, data rights and governance, technical and security, economic characteristics, clinical characteristics, and user preferences. In Delphi round one, participants commented on the proposed constructs and submitted their own. A thematic analysis identifying key concepts and themes of the participant proposed constructs and comments was used to incorporate this information for round two. Then, participants rated each value construct on an ‘importance’ Likert scale in two decision contexts: user-facing DHTs and system-facing DHTs. In round three, participants were presented with the consensus judgement for each construct, with the opportunity to change their answer. Value constructs with equal to or greater than 70 percent consensus were included in the final framework. Rounds four and five were, respectively, value judgements on a Likert scale and a presentation of consensus for a therapeutic area to test the final framework.
Results
Initially 32 value constructs were proposed by researchers, 20 of which were changed or removed based on round one feedback. Additional constructs were added based on participant suggestions resulting in forty-five value constructs in round two. The final framework will be available after round three closes on 20 December 2022.
Conclusions
The multi-stakeholder Delphi approach ensures that all suggestions and value judgements are weighted equally across stakeholder groups. The resultant value framework can be used to inform policymaking around health technology assessment of DHTs.
