System-Value Integration: A Dynamic Model for Digital Health Ecosystems

Gentili et al.'s review highlights digital health's heterogenous CEA outcomes, while Liu et al.'s cardiac rehab DTx study shows per-patient QALY gains but ignores system-wide impacts. This research proposes a "Digital Ecosystem Value Model" using agent-based simulation to map ripple effects: e.g., how a tele-mental health app reduces ER visits or how AF screening alters stroke care pathways. Unlike static Markov models, this captures dynamic interactions like "crowding out" of low-value care or workforce reallocation. It addresses Gentili’s call for standardized methods by quantifying system efficiency—a metric overlooked in current CEAs but critical for policymakers.

References:

1. The cost-effectiveness of digital health interventions: A systematic review of the literature. A. Gentili, G. Failla, A. Melnyk, Valeria Puleo, Gian Luca Di Tanna, W. Ricciardi, F. Cascini (2022). Frontiers in Public Health.
2. Cost-effectiveness analysis of digital therapeutics for home-based cardiac rehabilitation for patients with chronic heart failure: model development and data analysis. Tianyi Liu, Yiyang Zhan, Silei Chen, Wenhong Zhang, Jian Jia (2023). Cost Effectiveness and Resource Allocation.