Digital Therapeutics Provide Benefits but Require Further Research

A Substance Abuse and Mental Health Services Administration (SAMHSA) Advisory report indicated that while digital therapeutics (DTx) can address care barriers, such as limited care access and high costs, development efforts are on the rise, prompting further considerations.

Amid the growth of technological capabilities, DTx are also on the rise. DTx consist of software that addresses diseases through various therapeutic interventive efforts. Often provided as prescription digital therapeutics (PDTs), these resources treat mental health conditions and substance use disorders.

Research indicates that DTx are projected to grow in the coming years. A part of the National Institutes of Health (NIH), the National Institute on Drug Abuse (NIDA) funds a Center for Technology and Behavioral Health (CTBH) that guides the creation and application of digital health resources for various conditions, often providing grants.

Other organizations, such as the National Institute of Mental Health (NIMH), the Digital Healthcare Research Program at the Agency for Healthcare Research and Quality (AHRQ), and the Department of Veterans Affairs (VA), are also striving to research and validate DTx.

Although the use of digital resources often involves access issues which can lead to disparities, DTx recognizes these while addressing common care barriers. Typically, behavioral healthcare has access issues, stigmas, high costs, and other roadblocks. DTx, however, provides remote options with or without clinicians, anonymity, and reduced out-of-pocket costs for clients.

Lowering costs is an important benefit, primarily due to the extent it is considered when adopting interventions. According to research, enhanced efficiencies in care, improved retention rates, and a reduced need for pharmaceuticals are among the benefits of using DTx for behavioral health. These factors are important to consider when deciding whether to reimburse DTx.

Beyond this, insurance considerations for DTx are extensive for Medicare, Medicaid, and private insurers. For example, ensuring that a service applies to a statutory benefit category, is not directly excluded from coverage, and contains practicality are factors that Medicare considers.

Although an established framework for reviewing DTx has yet to be developed, a report by the Agency for Health Research and Quality (AHRQ) highlighted a tool for assessing mental health apps. The report established the Framework to Assist Stakeholders in Technology Evaluation Recovery (FASTER). FASTER assists providers and patients in evaluating mental health applications. Through questions related to integrity and care access, FASTER establishes a risk level associated with the app. It also assesses the functionality of the app along with its relationship with goals.

Furthermore, the SAMHSA Advisory report highlighted the need to ensure equity when using DTx. Access to technology, digital literacy, cultural appropriateness, and affordability are among the main considerations.

Similarly, research from Forrester from July 2022 provided insight into the benefits and risks of DTx.

Shared with mHealthIntelligence via email, the report defined strengths, weaknesses, opportunities, and threats associated with DTx. This data came from interviews with various DTx companies.

The main strengths included ease of use, high access levels, and data collection. Weaknesses included limited clarity surrounding reimbursement, use, and differentiation.

Augmentation of the clinician workforce and supporting care in an increasingly digital landscape are opportunities linked to DTx, along with managing physician burnout and expanding patient options. Enhancement of predictive analytics is also an opportunity. Threats, however, include those related to security, timelines, and limited organizational commitment.

These two reports are integral examples of what should be considered when implementing DTx. As they are anticipated to grow in the times to come, their use must be well-navigated.