Virtual, augmented, mixed, and extended reality interventions in healthcare: a systematic review of health economic evaluations and cost-effectiveness

Introduction Health economic evaluations are required to best understand the value of interventions to the health economy. As extended reality technologies (an umbrella term including virtual, augmented, and mixed reality) become cheaper and more accessible it is likely that they will be used more within healthcare. Objective The aim of this study was to systematically review common practices within health economic evaluations of extended reality interventions in healthcare and to discuss the methods, outcomes, and methodological quality to inform future HEEs. Methods MEDLINE, Embase, NHSEED, PubMed, and the ACM Digital Library were searched, and studies retrieved and screened. We extracted descriptions of the population, intervention, comparator, outcomes, context, costs, and economic evaluation data from studies that fit our criteria. We included studies that involved healthcare patients who were provided extended reality interventions versus standard care, other types of care, or another extended reality application within the same setting where the outcome included both health outcomes and health economic evaluations. Results The search identified 1,693 records in total, of which 1,271 were excluded after title and abstract screening. A total of 422 articles were retrieved and screened and the majority ( n = 233) were excluded as they did not contain a health economic analysis or cost data. Fourteen articles were included in this review, all of which found that extended reality health interventions could provide cost savings. Our findings showed considerable heterogeneity between studies and a lack of clear descriptions of XR interventions, limiting their use within procurement. Conclusion Extended reality in healthcare has the potential to offer significant clinical benefits and research has shown it to be promising at delivering cost-savings. We make recommendations based on the findings of our review for future health economic analyses to help ensure that health economic analyses can support decision-makers in procuring these technologies. Trial registration PROSPERO 2022 CRD42022342110.