Table 2 Overview of health economic analyses

[22]

Chronic non-specific low back pain

Cost-utility analysis where benefits of a non-XR intervention are compared to a VR intervention both in terms of cost and QALYs*.

Payer

Clinic-based McKenzie extension therapy including clinic visits, transportation, and refreshments.

Treatment sessions, development of VR and its cost per patient, development of the Kinect and screen with cost per patient, transportation, and refreshments

Cost savings made in VR intervention due to no clinic visits, and reduced transportation and refreshment costs. Mean QALYs were .084 (95% CI, .083-.086) for control and .087 (95% CI .086-.088) meaning a .003 (95% CI .001-.004) QALY gain for VR. Independent t-test found significant difference in favour of VR (p=.003)

[23]

Rehabilitation for acute ischemic stroke patients

Cost-consequence analysis where costs and outcomes for patients receiving conventional therapy were compared to a matched group also receiving VR rehabilitation

Payer

Medical costs based on hospital billing during entire hospitalisation period (including hospital stay and medical costs), improvement in functioning, and reduction of stroke severity

Same as non-XR costs, did not include cost of VR

The VR intervention increased clinical benefit by reducing stroke severity and improving functioning. Medical costs lower in VR but it did not reduce hospital stays.

[24]

Rehabilitation for patients suffering stroke

Cost-analysis where the costs and outcomes from the addition of VR is compared to conventional therapy alone

Payer

Therapist salary based on average take home salary, cost of conventional therapy kits, and functional outcomes

Therapist salary based on average take home salary, cost of VR intervention including computer and with a lifespan of 5 years, and functional outcomes

Functional outcomes were similar. When therapist time is the same, VR is more expensive. The VR intervention becomes cost saving when therapist time is reduced to 25%

[25]

Rehabilitation for patients suffering stroke

Cost-analysis where the costs and outcomes of a VR intervention are compared to the costs and outcomes of clinic rehabilitation

Payer and societal (cost of private transport)

Therapist salary based on average take home salary, patient transport services (private), balance measures, and subjective feedback

Therapist salary and instrumentation (based on costs at time in Spain), balance measures, and subjective feedback

Provided overall costs showing that the VR intervention was cost saving due to reduced therapist contact and no travel expenses. No difference in outcomes

[26]

Patients with combat-related PTSD*

Cost-benefit analysis comparing VR exposure therapy costs to cost of training soldiers

Societal

Included cost of training for soldiers at different levels and clinical psychologist salary

Cost of clinical psychologist salary. Cost of VR not included

Cost savings are made where soldiers remain on active duty when clinical psychologist time but not VR costs are considered

[27]

Agoraphobia in patients with psychosis

Cost-utility analysis and cost-consequence analysis where benefits of treatment as usual plus a VR intervention is compared to treatment as usual alone, both in terms of cost, outcomes, and QALYs

Payer and societal (unpaid care)

Resource and service use including visits, hospitalisations, medications, and therapies based on self-report and medical record checks, criminal justice contacts and unpaid care measured by self-report, alongside QALYs

Same as non-XR. Cost of VR not included but proposed cost based on cost-effectiveness

A maximum cost-effective price was estimated based on both a payer and societal perspective using cost and outcome data. Cost-effective from a payer perspective only if targeted to patients with greater need, cost-effective from societal perspective

[28]

Treatment of children with eosinophilic esophagitis requiring serial endoscopic, visual and histologic assessment

Cost-minimisation analysis comparing VR during transnasal endoscopy to sedation during EGD*

Payer

Estimated charge for sedated EGD with biopsy under general anaesthesia alongside completion rates, adverse events, and duration in clinic

Estimated charge for transnasal endoscopy with biopsy alongside completion rates, adverse events, and duration in clinic. Cost of VR not included

Use of VR led to a cost saving of 53.4%

[29]

Pain management in inpatient setting

Model-based approach using a cost-consequence where inpatient medication use, patient satisfaction and length of stay are compared with and without VR pain management

Payer

Inpatient opioid utilisation estimates using MEDLINE, length of stay, reimbursement for improved patient satisfaction (HCAHPS* and VBP* reimbursements)

Same as non-XR costs. VR was fixed cost based on annual licence, technician salary, variable costs (e.g., disinfectant wipes), and costs of minor and major adverse events (estimated)

Cost saving only where length of stay was reduced

[30]

Exercise programme for haemodialysis patients

Cost-consequence analysis where an intradialysis exercise program was combined with a VR game and compared with usual care measured prior to implementation

Payer

A micro-costing approach was taken measuring laboratory tests, outpatient visits, hospital pharmacy use, healthcare provision, hospitalisation, and radiology tests. Additionally included measure of functional capacity

Same as non-XR costs, did not include cost of VR

Functional outcomes were similar. The use of the VR intervention led to a significant decrease in healthcare costs due to reduced resource use (significant for outpatient visits, laboratory tests, and radiology tests).

[31]

Physical therapy for total knee arthroplasty

Cost-minimisation analysis comparing the costs and outcomes of a VR therapy to conventional therapy

Payer

Total healthcare costs service use and reimbursement, functional capacity, and adverse events (e.g., falls)

Same as non-XR and with a total cost assigned for therapist time, did not include cost of VR

No difference in effectiveness on clinical measures. Lower costs are reported for patients using the VR intervention with fewer hospitalisations

[32]

Wound care for flame burns

Cost-analysis where anaesthesia assisted procedure costs are compared to use of VR hypnosis

Payer

Anaesthesiologist and associated equipment and supplies, subjective statements of pain and anxiety provided by both patient and clinicians

Not included

Based on replacing anaesthesia assisted procedure costs with non-costed VR

[33]

Pain management during surgery

Cost-minimisation analysis where cost of VR intervention compared against cost of local anaesthesia during ambulatory surgeries

Payer

Approximate cost of lipoma removal surgery in different services

Not included

Found that less pain was reported in VR intervention and heart rate was similar. Costs could be reduced by between 17.11% and 30% in different healthcare settings.

[34]

Patients with social anxiety

Cost-minimisation analysis comparing the cost of VR exposure therapy with exposure therapy done in-vivo

Payer

Therapist time

Cost of VR not included but proposed cost based on cost-effectiveness

Reported a cost saving for VR therapy where it did not have a cost or where a set number of sessions reduced therapist time

[35]

Treatment of paranoia in psychosis

Cost-utility analysis and cost-consequence analysis comparing costs, outcomes and QALYs for VR CBT plus usual care to usual care alone

Payer and societal (cost of travel and lost productivity)

Direct medical costs using health service costs, travel to and from clinics, productivity based on work status and expressed as hourly productivity costs, and resource use based on a questionnaire

Same as non-XR and including a per patient cost for VR based on subscription cost

Cost per QALY gained at follow up was estimated to be €48,868 with 99.98% showing improved QALYs. Costs were lower when differences in safety behaviour and psychiatric admission costs were included