Digital platforms in technology-enhanced care management of chronic health conditions: A systematic review of the international economic evidence

Background: Chronic diseases such as Type 2 Diabetes, Asthma, Chronic Obstructive Pulmonary Disease (COPD), and Cardiovascular Disease are responsible for almost three-quarters of preventable deaths worldwide and place increasing pressure on healthcare systems. These long-term conditions also account for a large proportion of global health expenditure. Digital health technologies, including telemedicine, remote monitoring, and mobile health platforms, are increasingly promoted as innovative ways to improve patient outcomes, reduce unnecessary hospital use, and extend care delivery into communities.

 

 While there is strong policy interest in their use, questions remain regarding their clinical effectiveness, patient acceptability, and economic value. This systematic review aimed to examine the international evidence on digital health interventions for chronic disease management, with particular attention to quality of life and cost-effectiveness.

 

Approach: A systematic search of EMBASE, PubMed, CINAHL, and Scopus was conducted for studies published between 2015 and 2025. We included evidence on digital health interventions targeting adults with Type 2 Diabetes, Asthma, COPD, or Cardiovascular Disease. Two reviewers independently screened titles, abstracts, and full texts, with disagreements resolved by consensus. Methodological quality was assessed using Joanna Briggs Institute (JBI) critical appraisal tools. The final review included 23 studies: 7 randomised controlled trials, 5 non-randomised trials, 6 cohort studies, 4 qualitative studies, and 1 economic evaluation.

 

Results: Clinical effectiveness outcomes were consistently positive. Across all conditions, 86% of reported outcomes exceeded minimal clinically important difference thresholds, with improvements in HbA1c, lung function, exercise tolerance, and quality of life measures. Benefits were sustained in 85% of follow-up studies, indicating that digital health solutions can deliver lasting impact when integrated into ongoing care.

Healthcare utilisation reductions were also well documented. Hospital admissions fell by 25–77% across 15 studies, emergency department attendances by 35–55%, and when hospitalisation was required, length of stay was reduced by an average of 2–4 days compared to standard care. These findings were consistent across 12 different healthcare systems, highlighting international applicability.

 

Economic evidence was limited but promising. Annual cost savings ranged between €2,300 and €5,200 per patient, with return on investment estimates between 1.4:1 and 3.6:1. One full economic evaluation reported cost-effectiveness at €12,500 per Quality Adjusted Life Year (QALY), which falls within widely accepted thresholds. However, only 9% of included studies conducted a full economic analysis, leaving a clear evidence gap.

 

Patient perspectives were strongly positive. Acceptance rates ranged from 85–95% across age groups, demonstrating that with adequate training and support, older adults achieved clinical outcomes equal to or better than younger users. Key success factors included clinical champions, structured training, and technical support. Importantly, outcomes were determined by system-level support, showing that digital equity is achievable with appropriate design and implementation.

 

Implications: This review demonstrates that digital health interventions are clinically effective, well accepted by patients, and can deliver meaningful reductions in healthcare utilisation. While early evidence of cost-effectiveness is encouraging, robust economic evaluations remain scarce. To maximise impact, future implementation should prioritise scalable models supported by infrastructure, training, and equity-focused approaches.

Keywords: digital health, chronic disease management, cost-effectiveness, quality of life