Health technology assessment (HTA) frameworks used for making public funding decisions on digital health technologies (DHTs) have not been informed by large stakeholder preference studies and rarely cover all nine domains of the widely used EUnetHTA “Core Model”. Our aim was to develop a literature-informed and stakeholder-prioritised checklist of DHT-specific considerations for DHTs that manage chronic disease that extends an internationally established HTA framework. We conducted two systematic reviews to identify: (i) DHT evaluation frameworks and (ii) primary research on DHTs published until 20 March 2020. Stakeholder prioritisation of issues was performed using a best-worst preference study among a broad cross-section of patients, carers, health professionals, and the general population in Australia, Canada, New Zealand, and the UK. Systematic review issues were prioritised and adapted for use as a practical checklist. DHT evaluation content was recommended by 44 identified frameworks for 28 of the 145 issues in the Core Model and for 22 new DHT-specific issues. A coverage assessment of 112 clinical studies of remote treatment and self-management DHTs for patients with cardiovascular disease or diabetes revealed that less than half covered DHT-specific content in all but one domain, or traditional HTA content in clinical effectiveness and ethical analysis. The preference survey of 1,251 stakeholders identified broad agreement on the 12 most important DHT attributes, six of which were related to safety. The most important attribute was “helps health professionals respond quickly when changes in patient care are needed”, which is not a focus of existing DHT HTA frameworks. Using the thesis-developed checklist in conjunction with the Core Model can enable users to perform a DHT-specific and comprehensive HTA on DHTs that manage chronic disease and can assist primary researchers to collect appropriate data to inform this HTA
