Keywords

1 Introduction

The World Health Organization emphasized that efforts to remove environmental and social barriers are needed to overcome the difficulties experienced by people with disabilities, and it has been confirmed that the people with disabilities rely on other people or assistive technology devices when necessary to carry out their daily activities [1].

The Korean government supports assistive technology device for the people with disabilities and the elderly through 9 projects in 4 departments (Ministry of Health and Welfare, Ministry of Employment and Labor, Ministry of Science and ICT, Ministry of Education) and 1 department (Ministry of Patriots and Veterans Affairs). Researchers reported that the use of assistive technology improves independence and quality of life, affects family and social burdens, and reduces the help of others [2,3,4,5]. This means that it is important to provide appropriate and effective assistive technology devices according to the needs and abilities of the subjects, and in-depth evaluation by occupational therapists, regular inspection of assistive technology devices, and cooperation with other experts are required [6, 7].

In Korea, the health insurance budget was gradually estimated from 2017 to 2022 to alleviate the burden of the vulnerable, and in particular, health care plans to alleviate economic difficulties and cost burdens were emphasized to ensure people-centered universal health [8,9,10]. Accordingly, plans and measures to efficiently use the limited budget of the state are required [11]. Kong and Jung [12], cost-effectiveness, cost-utility, and cost-benefit analysis are common techniques for confirming economic feasibility. However, related research in Korea is very scarce. According to WHO [2], through the support of appropriate assistive technology devices, the state not only reduces medical costs and additional welfare budgets due to repeated hospitalization of users such as the disabled and the elderly, but also provides socio-economic value by enabling users’ economic activities reported to be able to create.

Therefore, this study analyzes the economic feasibility of providing assistive technology devices or services, systematically reviews studies that derive economic and non-economic values, and analyzes economic analysis techniques and measurement tools used in the economic analysis. Through this, plans to efficiently use the government’s limited budget in the field of rehabilitation in Korea will be presented.

2 Method

2.1 Database and Search Term

The databases for literature search for this study are the National Digital Science Library (NDSL), Korea Citation Index (KCI), Scopus, and Web of science. Articles included domestic and foreign academic journals published from February 2018 to February 2023 based on the publication date.

Search terms are (“Economic analysis” OR “economic evaluation” OR “Cost-benefit” OR “Cost-effectiveness” OR “Cost-efficiency”) AND (“Assistive device” OR “Assistance tool” OR “Assistive Technology device” OR “Assistive Technology service” OR “Assistive Technology”) was searched, and it was translated into Korean and used in the KCI and NDSL databases. Papers retrieved from each database were integrated through Endnote 20, duplicated articles were removed, and then selected based on the following inclusion and exclusion criteria.

2.2 Selection Criteria

Each article was selected if it satisfies the following criteria.

  1. (1)

    Articles published in academic journals

  2. (2)

    The article analysing the economic value of ATD or ATS

  3. (3)

    The article analysing the non-economic value of ATD or ATS

  4. (4)

    Thesis written in Korean or English

And, if each article satisfies the following criteria, it was excluded.

  1. (1)

    The article analysing only the effectiveness of ATD or ATS

  2. (2)

    Review or meta-analysis research, degree research, protocol research thesis

  3. (3)

    Articles for which full text cannot be obtained

Since this study only considered studies analyzing the economic feasibility of assistive technology devices and services and studies reviewed through peer review, systematic reviews, meta-analyses, and degree studies were excluded. In addition, articles that could not be read or whose economic feasibility was not analyzed were excluded. The literature was independently reviewed by two researchers and finally selected through discussion. Finally, 19 articles were selected (Fig. 1).

2.3 Quality Level of Research

The quality level of the final selected articles was evaluated using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) checklist. The checklist was announced in 2013, the qualitative level of the economic evaluation was evaluated by Drummond et al. [13], after responding with ‘Yes’, ‘No’ or ‘Not Applicable’, if the item meets the guidelines, 1 point (yes), and half of it, 0.5 points (partial), if not satisfied at all, it can be calculated as 0 points (no). As the checklist was revised in 2022 through an expert Delphi survey from 2020, so the 2022 version of the revised CHEERS checklist was used in this study. The CHEERS checklist 2022 has added items related to patient or service recipient, general public, community or stakeholder engagement and involvement, and terminology has been expanded for broader applicability. And modifications have been made to make the analysis more transparent and to help readers decision-making, including items such as whether the economic analysis was planned and whether the model used could be used by anyone [14].

2.4 Analysis

In this study, the frequency of Type of Assistive Technology Device (ATD) or Service (ATS), Type of economic analysis methods, and Measurement tools used in the article was analyzed, and the Results of the Quality level of research were analyzed.

Fig. 1.
figure 1

Flow diagram of article selection.

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3 Result

3.1 Analyzed Assistive Technology Device (ATD) or Service (ATS)

Among the types of assistive technology devices and services analyzed in the final selected literature, hearing aids showed the highest frequency, and the study was conducted targeting the people with hearing disabilities due to disease and the elderly population. Next, there were many analyzes on assistive technology, hearing service, and manual wheelchair. In addition, the economics of vehicle modification, prosthesis, rollator, and upper limb robot was analyzed in one article each (Table 1).

Table 1. Type of Assistive Technology Device or Service.
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3.2 Used Economic Analysis Methods

The techniques used in the analysis were cost-effectiveness, cost-benefit, and cost-utility analysis, and cost-effectiveness techniques were used most frequently. Among the economic analysis methods mentioned above, the cost-effectiveness method was used the most, and it was also used in various assistive technology device and service studies, but the high proportion of the papers on economic analysis on hearing aids had an impact. Additionally, there was one article each on the social value of assistive technology and telecare (ATT), and vehicle modification (Table 2).

Table 2. Type of Economic Analysis Method
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3.3 Measurement Tools by Cost and Outcome

In the analyzed studies, costs were generally determined through unit costs, based on national surveys or published data. Direct costs typically included initial consultation, intervention costs such as assistive technology devices or services, evaluation and training, and, if necessary, surgery costs. Indirect costs included transportation and opportunity costs for individuals and caregivers, and non-working hours.

Outcome tools measured as a result of economic analysis were analyzed. Of the 11 tools, the tools to evaluate health and quality of life accounted for a high proportion of 5, and among them, quality adjusted life year (QALY) was used the most. QALY is a well-known measure of the degree to which a treatment or system improves quality of life while prolonging lifespan, and it has been pointed out that it is a measure tailored to the individual rather than society. Next, EQ-5D and HUI3 were used as questionnaire tools to measure health utility. The EQ-5D responds to mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Similarly, HUI3 responds to the state of eight attributes, such as vision, hearing, and ambulation, etc. And according to the purpose of the study, tools to evaluate elderly people with dementia and tools to evaluate people with disabilities who are working were used.

In addition, five articles analyzed complications prevented through assistive technology devices and services, cost reduction, and durability of devices themselves as outcomes, and two articles that studied social values measured non-economic values through questionnaires and CVM (Table 3).

Table 3. Outcome Measurement tool of included studies
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3.4 Results of the Quality Level of Research

The total score range of CHEERS 2013 checklist ranges from 0 to 24, and higher scores mean excellent quality levels, and can be divided into excellent (24 points), good (17.5 to 23 points), average (11.5 to 17 points), and poor (11 points or less) [13]. However, since the revised CHEERS 2022 checklist has not yet been presented and consists of 28 items, this study classified it into excellent (28 points), good (20.5–27.5 points), average (13.5–20 points) and poor (13 points or less) based on previous studies. As a result of the analysis, the total score ranged from 17 to 27 points, and one of the four studies conducted according to CHEERS checklist scored the highest with 27 points. Two articles that studied the cost-benefit of lightweight manual wheelchairs were excluded from the analysis because only limited information was provided. Therefore, 17 articles were evaluated in this study (Table 4).

Table 4. Level of Quality of included studies
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4 Conclusion

The application of assistive technology devices and services has a great impact on the lives of people with disabilities, improves their lives, and enables new attempts, so they must be attempted. The Korean government is also making great efforts for this, but so far, limited application is being made. Therefore, this study attempted to provide basic data for improving the existing system by systematically reviewing studies that analyzed the economic and non-economic values of assistive technology devices and services. As a result of analyzing previous studies, both economic and non-economic values of assistive technology devices and services for the people with disabilities were measured, and the economic value was mainly calculated through a unit cost based on national survey and published data, and the non-economic value was calculated through QALY, questionnaires and conditional value evaluation (willing to pay). Also, Outcome measurement tools were mainly related to health and quality of life. Through this, the government will provide efficient support without wasting budget, and people with disabilities can expect to improve their quality of life by reducing the burden in purchasing and using necessary assistive devices and services. Lastly, In Korea, there are few studies that have confirmed the effectiveness, benefits, and utilities of assistive technology devices and services on the health and life of people with disabilities who use and receive them. Accordingly, it is expected that researches that measure the economic and non-economic values of various ATDs and ATSs in Korea according to an objective checklist will be actively conducted in the future.