Cost-Effectiveness of Electronic Patient-Reported Outcome Measure Interventions in Cancer: Systematic Review and Parameter Extraction for Economic Modeling.

چکیده اصلی

BACKGROUND: Complex digital interventions that integrate electronic patient-reported outcome measures (ePROM) into clinical practice in cancer have the potential to improve quality of life, increase survival, and reduce health resource use and costs. Such systems can help patients with cancer self-manage chemotherapy symptoms, reduce clinicians' workloads through automated decision support, and resolve problems earlier. However, more research on the cost-effectiveness of ePROM monitoring is needed. OBJECTIVE: This paper comprises two complementary components: (1) a systematic literature review summarizing and evaluating the quantitative and qualitative evidence related to the cost-effectiveness of ePROM monitoring and (2) a health economic model parameter extraction. We also conducted supplementary targeted searches and scoping to provide context to our findings. METHODS: We searched Ovid (including MEDLINE and Embase), Scopus, and the International Health Technology Assessment Database for original English-language papers published on or before March 2025 using search strings that combined terms related to ePROMs, health economics, and cancer/oncology. We included papers reporting health economic-related outcomes for ePROM interventions designed for adult cancer populations and excluded screening tools and conference abstracts. RESULTS: We included 34 publications from 27 unique studies and identified and analyzed 26 ePROM-integrated interventions within these. Most (23/26) of the included interventions explicitly described some form of alert handling and automated decision support based on remote ePROM monitoring. Of the 34 publications, 5 presented full cost-effectiveness analysis results, of which 3 were highly uncertain and lacked clear differences in costs and health outcomes between ePROMs and standard care; conversely, 2 presented strong evidence of cost-effectiveness due to quality-of-life improvements, reduced hospitalizations, and potentially more autonomy in health-related travel (eg, ePROM-monitored patients can drive or walk to the hospital instead of using taxis or ambulances). A further 5 publications reported partial health economic results (eg, cost-consequence and budget impact), of which 1 detected no difference in strategies; in contrast, 4 reported lower health resource use and costs of ePROMs, mainly due to hospitalization reductions. Overall, 12 of the 27 studies included a qualitative component but mostly focused on user experience and design-related themes; only 2 of these addressed economic-specific themes (eg, changes in workflow and resource use due to ePROM implementation and integration), indicating some potential for time saving due to ePROM monitoring. CONCLUSIONS: Some ePROM-integrated interventions demonstrated cost-effectiveness in cancer care, but the evidence base remains limited. Where evidence does exist, cost-effectiveness appears driven by reduced hospitalization and improved quality of life. Qualitative research within the included studies rarely addressed economic questions. We provide a detailed parameter extraction for use in future economic modeling and recommend research priorities, including quantitative mapping of ePROM symptom data onto health resource use patterns, and qualitative work exploring how ePROM implementation affects clinical workloads and patient-perspective costs.

ترجمه فارسی چکیده

مداخلات دیجیتال پیچیده که شامل اندازه‌گیری نتایج گزارش شده توسط بیمار الکترونیکی (ePROM) در مراقبت‌های سرطانی هستند، پتانسیل بهبود کیفیت زندگی، افزایش بقا، و کاهش استفاده از منابع و هزینه‌های سلامت را دارند. این سیستم‌ها می‌توانند به بیماران سرطانی کمک کنند تا علائم شیمی‌درمانی را خودمدیریت کنند، بار کاری متخصصان را از طریق پشتیبانی تصمیم‌گیری خودکار کاهش دهند و مشکلات را زودتر حل کنند. این مقاله شامل دو جزء مکمل است: (۱) مرور نظام‌مند ادبیات که شامل ارزیابی شواهد کمی و کیفی مربوط به هزینه‌های مؤثر ePROM است و (۲) استخراج پارامتر مدل اقتصادی سلامت. ما شواهدی از ۳۴ انتشار در ۲۷ مطالعه منحصر‌به‌فرد شناسایی کردیم که در آن ۲۶ مداخله شامل ePROM تحلیل شدند. اکثر مداخلات (۲۳/۲۶) توصیفی از هندل کردن هشدارها و پشتیبانی تصمیم‌گیری خودکار بر اساس نظارت از راه دور ePROM ارائه دادند. از میان ۳۴ انتشار، ۵ نتیجه‌های تحلیل هزینه‌های مؤثر را ارائه دادند که ۳ مورد دارای ابهام بالا و تفاوت واضحی در هزینه‌ها و نتایج سلامت بین ePROM و مراقبت استاندارد نداشتند. در مقابل، ۲ مورد شواهد قوی از هزینه‌های مؤثر را نشان دادند که عمدتاً ناشی از بهبود کیفیت زندگی و کاهش بستری بود. ۵ انتشار دیگر نتایج اقتصادی جزئی (مانند هزینه-پیامد و تأثیر بودجه) را گزارش کردند که ۴ مورد آن‌ها کاهش استفاده از منابع و هزینه‌های ePROM را نشان دادند. در مجموع، ۱۲ مطالعه از ۲۷ مطالعه یک مولفه کیفی داشتند که اغلب بر تجربه کاربری و موضوعات طراحی تمرکز داشتند. ما پارامترهای دقیقی برای استفاده در مدل‌سازی اقتصادی آینده ارائه می‌دهیم.

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