EDEN: Economic Design & Evaluation for Digital Prevention

Preventive health interventions consistently demonstrate strong clinical benefit yet remain difficult to adopt, integrate, and finance within real-world health systems. This implementation gap is driven not by deficiencies in efficacy, but by misaligned time horizons across stakeholders. Payers, providers, employers, and patients each apply different implicit discount functions that render long-term preventive value unattractive when evaluated against short-term operational and budgetary constraints.

Objectives

This study introduces EDEN (Economic Design & Evaluation of Digital Prevention), a computational framework designed to optimise the time-value architecture of preventive interventions using the 4R model: Reach (time-to-detection), Retain (time-to-behaviour change), Report (time-to-evidence), and Reimburse (time-to-return). The objective is to determine how these four timelines must be configured to enable adoption, integration, and investment.

Research questions

RQ1: How do stakeholder-specific discount functions influence the feasibility of adopting and financing preventive interventions?

RQ2: In what ways do digital health technologies (e.g., digital biomarkers, AI risk screening) enable preventive care?

RQ3: How to accurately model the viable 4R timelines (Reach, Retain, Report, Reimburse) required for prevention to succeed?

Learn more…
About our computational framework >> eden.ethz.ch <<
About our Swiss implementation project >> prevention.ch/project/eden <<
About our social longevity survey >> helo-nus.com <<

Our methods

EDEN integrates insights from three analytic modules—system-fit analysis, health technology assessment (HTA), and financial modelling. System-fit analysis identifies stakeholder-specific discount functions and incentive misalignments. The HTA module computes time-discounted health-adjusted outcomes, while the financial module estimates breakeven thresholds, ROI trajectories, and valuation curves. The framework is demonstrated through a proof-of-concept analysis of B2C digital diabetes screening in Switzerland.

We use a mixed-methods approach to make digital prevention implementable and investable:

Primary data – surveys, interviews, and focus groups to capture stakeholder perspectives and real-world implementation challenges.
Secondary data – scientific literature, startup/financial databases, and policy reports to benchmark evidence and market dynamics.
Computational techniques – unsupervised clustering, natural language processing (topic modeling), and network analysis to identify value propositions and collaboration patterns.
Financial simulation – breakeven, discounted cash flow, and scalability modeling to assess economic viability.

Our research platform, EDEN (eden.ethz.ch), integrates these methods with Retrieval-Augmented Generation (RAG) to dynamically map stakeholder incentives and simulate venture outcomes.

From insight to impact.

EDEN identifies the feasible temporal boundaries for each 4R dimension. The model shows how accelerated detection, earlier behavioural inflection points, compressed outcome visibility within payer budgeting cycles, and reimbursement aligned with ROI horizons jointly determine adoption viability. The analysis also reveals why evidence-rich digital therapeutics, exemplified by Pear Therapeutics, fail when their 4R timelines exceed stakeholder discount thresholds.

Publications

EDEN: Towards a Computational Framework to Align Incentives in Healthy Aging, Mekniran, W. and Kowatsch, T. (2025). 10.5220/0013359800003911. [PDF]
Incentive Systems for Diabetes Prevention with Digital Health, Mekniran W, Jovanova M & Kowatsch T (2024), Poster to be presented at Annual Meeting of the Swiss Society of Endocrinology and Diabetology (SSED) on November 14-15, 2024.
The Longevity Landscape: Value Creation for Healthy Aging, Mekniran W, Giger O, Fleisch E, Kowatsch T, Jovanova M (2024), preprint, 10.1101/2024.05.28.24308017. [PDF]
Collaboration and Innovation Patterns in Diabetes Ecosystems, Giger, O.F., Pfitzer, E., Mekniran, W., Gebhardt, H., Fleisch, E., Jovanova, M., Kowatsch, T., (2024), preprint, 10.1101/2024.04.25.24306351. [PDF]
Reimagining Preventive Care and Digital Health: A Paradigm Shift in a Health Insurance’s Role, Mekniran W, Kramer J-N and Kowatsch T (2024), 10.5220/0012400300003657. [PDF]
Scalable Business Models in Digital Healthy Longevity: Lessons from Top-Funded Digital Health Companies in 2022, Mekniran W, Kowatsch T (2023), 10.5220/0011778400003414. [PDF]

Thesis Contributions

Prevention in Health Care: Case studies to derive success factors – Winkelmann S.
Business Model Innovation in Digital Healthcare: A systematic literature review – Stalder V.
Business Model Innovation in Preventive Care: A systematic literature review – Diethelm W.
Analysis of Business Model Robustness of Swiss Digital Health Ventures – Jordi S.
Healthcare Ecosystems for Preventive Care: Role of Swiss health insurance – Cathomas C.
Revenue Model Analysis of Digital Healthy Longevity Companies – Klebinger K.
Framework for Evaluating Business Models of Digital Scribes – Kubiak M.
Pharma in Digital Therapeutics for T2D Prevention: Business & Revenue Models – Kühne J.
Financing Digital Health Prevention: Overcoming Scalability in Switzerland – Josi M.
Understanding Success in Digital Diabetes Prevention: A Case Study – Wurbs C.

Looking for a thesis?

Survey Study on Heatlhy Longevity: Assessing Swiss perceptions of healthy longevity medicine, willingness to pay for preventive care, and the adoption of digital health technologies among healthcare professionals. More about our social longevity survey >> helo-nus.com <<

Feel free to apply by sending your CV and research proposal to wmekniran@ethz.ch

In Brief

Our team is developing an evaluation framework that makes disease prevention measurable, actionable, and accountable.

Runtime

Nov 2022 – May 2026

Research Team

Wasu Mekniran MSc MBA
Mia Jovanova PhD
Prof. Dr. Elgar Fleisch
Prof. Dr. Tobias Kowatsch

Contributing Members
Christoph Wurbs
Janine Kühne
Magdalena Kubiak
Michel Josi
Keno Klebinger
Céline Cathomas
Severin Jordi
Wilma Diethelm
Victoire Stalder
Sandra Winkelmann