Accelerating the digital transformation of the healthcare in the EU through sound evaluation to show cost-effectiveness of digital solutions

By dr. Frans Folkvord

Co-director of PredictBy and associate professor at Tilburg School of Humanities and Digital Sciences at Tilburg University.

Transformation of health and care for a digital Europe is a highly promising adaptation that will benefit people, health care systems and the economy. More specific, digital technologies such as mobile and remote communication technologies, artificial intelligence and big data analytics, supercomputing powers, and many other new technologies, offer new opportunities to transform the way we receive and provide health and care services, enabling innovative approaches to independent living and integrated health and social care for a healthy living and ageing.

Testing solutions across the EU, and beyond

Currently, PredictBy is actively involved in the GATEKEEPER project with the evaluation of several technological solutions across Europe, working closely together with the pilot-sites (from Basque country, Aragon, Saxony, Puglia, Poland, Milton Keynes, Greece and Cyprus) included in the GATEKEEEPER consortium. The evaluation is designed to systematically assess the application of GATEKEEPER platform services, with the aim of improving the quality of life of citizens while demonstrating its significant efficiency gains in health and care delivery across Europe. To start with, the experimental design and key performance indicators have been established together with the pilots in order to structurally examine the outcomes and show the effectiveness of the deployment of technical solutions that will involve around 40,000 elderly citizens in 8 regional communities from 7 EU member states. It is of great importance to establish the experimental design and key performance indicators at the very beginning of the process. Currently we are working closely with several pilot sites in Asia to extend the lessons learned from GATEKEEPER outside of the EU.

GATEKEEPER provides a great opportunity to establish all necessary elements of a large pilot site deployment of highly promising technological solutions to improve healthcare across Europe, also for extended technological solutions that are not yet working inside of the GATEEKEEPER project. Conducting these important methodological activities a priori is essential to reap the benefits of this large European project efficiently. Whereas most interventions do not have the opportunity to use a multidisciplinary team like in GATEEKEPER, this creates the possibility to conduct this important work from a large number of perspectives. PredictBy and the pilot sites are doing great work on establishing the evaluation framework for the Gatekeeper project. This is much needed, considering the usefulness and relevance of valid and reliable outcomes that are the result of methodological sound designs to test advanced ICTs to improve quality of life of citizens across Europe.

Evaluating cost-effectiveness

Designing and implementing a methodological sound evaluation framework with valid and reliable key performance indicators is necessary to effectively test the outcomes of digital solutions in the healthcare sector. Subsequently, it provides the opportunity to conduct cost-effectiveness analyses to support evidence-based decision-making processes for stakeholders, such as health or social care providers, policy makers, companies or researchers, and also users in the health and care sector. Currently this is being conducting with the Monitoring and Assessment Framework for the European Innovation Partnership on Active and Healthy Ageing – MAFEIP tool to support evidence-based decision-making processes for all institutions and users in the health and care sector.

Due to the increasing healthcare costs worldwide, Health Technology Assessment (HTA) is becoming of great importance. HTA has used cost-effectiveness analysis to assess the new health technologies and interventions within health systems. The main objective of the MAFEIP tool is to estimate the outcomes of a large variety of social and technological innovations, by providing an early assessment of the likelihood that interventions will achieve their anticipated impact. In addition, MAFEIP also helps to identify the drivers of an interventions’ effectiveness or efficiency in order to guide further design, development or evaluation. Therefore, MAFEIP represents a clear support to the decision-making process for HTA. Given that healthcare costs are expected to continue increasing throughout the upcoming decades, it is now more urgent to have a clear understanding of which interventions and technological solutions are most effective and have the biggest impact, while also taking into account their relative costs.

Based on the MAFEIP tool, we get clear outcomes whether a technological solution is cost-effective or not, where the outcome of the project might be in four quadrants depending on cost and effect differences between intervention and non-intervention that you can see below. As shown in the figure, the top left quadrant signifies that the intervention conducted is dominant; it is more expensive and less effective than the alternative one, and therefore, it should not be implemented. If the outcomes of the HTA shows this result, the policy recommendation will be to exclude this intervention from implementation. On the other hand, if the outcomes falls within the bottom left quadrant, where the intervention dominates, the intervention should be applied as it is cheaper and more effective than the initial situation. In terms of the other two quadrants, the decision is less clear and needs additional assessment. Specifically, within the top right quadrant, the intervention is more effective but also more expensive. Regarding the bottom left quadrant, the intervention is cheaper, but less effective. In these two cases, the decision is determined by willingness to pay (WTP); a project should be implemented if the outcome is lower than the WTP (discontinue lines), as shown by the green points in the figure on the right side.

Would you like to be involved?

Did you develop a technological solution for healthcare provision with your company? Are you are part of a large consortium that is implementing health technologies and would like to connect to a larger network? Or are you simply interested in the GATEEKER project and you would like to hear more about it? Please reach out to the GATEEKEEPER community in order to seek collaboration opportunities and get more information on the projects outcomes.