|**Cost utility**<br>**analysis (a subset**<br>**of CEA)**|Incremental cost<br>effectiveness ratio<br>(effect in generalized<br>units) Net<br>health/monetary<br>benefits|Costs and effects<br>from a defined<br>perspective|Marginal<br>productivity of<br>health system (k);<br>ICERs of competing<br>investments|iDSI Reference Case;<br>[2] Drummond 2015<br>[46]|
|---|---|---|---|---|
|**Cost effectiveness**<br>**analysis**|Incremental cost<br>effectiveness ratio|Costs and effects<br>from a defined<br>perspective<br>Effects in natural<br>units|ICERs of competing<br>investments (in same<br>effect units)|<br>Drummond 2015 [46]|
|**Social return on**<br>**investment**|SROI|All costs and<br>benefits converted<br>to monetized<br>form, plus wider<br>social impact|<br>Understanding of<br>relative weight or<br>importance of<br>additional social<br>benefits|Olsen 2003 [47]|

The complexity and variety of DHIs and wide range of potential decision makers necessitates that the concept of “Return on Digital Investment” utilizing the DHI economic evaluation framework does not prescribe a particular form of aggregation, however it does require that researchers and decision makers are cognizant of the options available, the additional information required for their interpretation, and the risk of creating false certainty through obfuscation of important gaps in evidence, attribution, and valuation.

The use of the Impact Inventory in addition to value aggregation will assist in transparent representation of results, and it is expected that a comprehensive assessment of the Return on Digital Investment will involve a series of quantitative and descriptive outputs.

# 6. Using the DHI Economic Evaluation Framework

## 6.1 Case Example ONE

The overarching concept when applying the framework is to “comply or justify” – that is, users should attempt to adhere to the steps and principles of the framework, but where this is not feasible or appropriate, should provide justification for the methodological choice. In this way, the framework will facilitate methodological transparency over conformity, improving the overall usefulness of economic evaluations of DHIs.

This section details the initial planning steps for application of the framework to the evaluation of an information system and predictive analytics intervention to serve as an example of how the framework can be used to plan the methodological approach. As more evaluations utilize the framework, further examples will enable refinement of methods specifications.

The example analytic plan utilizing the framework is an economic evaluation of the Orbit data capture system and the Zenysis data analytics platform compared to a pre-implementation scenario in a targeted population HIV prevention program in South Africa. Orbit is a webbased data collection and information management system for capturing programmatic performance information. Data entry is completed by health workers and enables the generation of multiple monitoring and evaluation indicators. The pre-implementation scenario against which Orbit is compared is an Excel-based information management system, where health workers would electronically send completed Excel templates monthly, entered