Does Digital Make a Difference? Willingness-to-Pay for Digital Versus Offline Weight Loss in Germany.

Abstract

Background: Germany introduced both digital health applications (DiGA) and an "offline" structured disease management program (DMP) for obesity within statutory health insurance. Given limited resources and ongoing reimbursement decisions, evidence on how individuals with obesity assessed the value of intervention delivery in terms of their willingness to pay (WTP) remained limited.

Objective: This study assessed the WTP of individuals with obesity (BMI ≥ 30 kg/m²) for a DiGA and a structured "offline" DMP and examined whether digital interventions better aligned with their preferences than offline interventions.

Methods: An online contingent valuation survey was conducted among 424 participants with a BMI ≥ 30 kg/m² in Germany. Monthly WTP under a hypothetical non-coverage scenario was analyzed in relation to participants' demographic and socioeconomic characteristics using a two-part regression model.

Results: The mean WTP for the DiGA was €16.15 per month (95% CI: €14.22-€18.09) and was significantly positively associated with older age (€0.24 higher per year, p = 0.02) and higher digital affinity (€6.91 higher per unit, p = 0.01). The mean WTP for the DMP was €18.70 per month (95% CI: €16.52-€20.90) and was significantly positively associated with female sex (€6.20 higher, p = 0.02) and higher digital infrastructure (€2.63 higher per unit, p = 0.04).

Conclusion: Respondents showed a positive WTP for weight loss interventions, yet at an amount far below DiGA manufacturer prices of approximately €70 per month. The small difference between digital and offline formats suggested that the perceived effectiveness of the intervention had a greater influence on WTP than the format.