The balancing act of digital therapeutics: How should the NHS bring global innovation in the clinical validation of apps home?
This is an excerpt of an article written for the DigitalHealth.London/Collaborate event on April 24th. Written by: Murray Aitken, Executive Director, IQVIA Institute for Human Data Science and Brian Clancy, Co-Lead & Associate Director, AppScript, IQVIA
Ahead of the Digital Therapeutics in the NHS Summit (London, UK; April 24, 2018), this article examines the need for evidence of the value of digital therapeutics within the NHS.
An IQVIA Institute for Human Data Science analysis suggests that if the NHS used digital health apps in five patient populations where they have reduced utilisation of acute care (diabetes prevention, diabetes, asthma, cardiac rehabilitation and pulmonary rehabilitation), this would save £170 million per year and improve health outcomes. If this level of cost saving – amounting to 1.1% – is extrapolated to total NHS expenditure, total cost savings of around £2 billion per year could be realised.
Figure 1: Cost Savings Associated with Using 5 Clinically Validated Apps Across 5 Initial Indications
Worldwide, over 318,000 health apps and 340 consumer wearable devices exist. Clinical evidence of app efficacy comprises at least 571 studies, including 234 randomised controlled trials and 20 meta-analyses. High-quality apps — those with characteristics such as high patient ratings, frequent updates, connectivity to sensors, endorsements, and promising clinical evidence — now exist for each major type of health care use.
Yet, only around 8% of studies of app efficacy to date have taken place in the NHS based on research from the IQVIA Institute. One reason may be the relatively low level of venture capital investment in UK digital health companies, which stands at 3% of the global total based on research from DigitalHealth.Network. Another may be the fact that some digital health entrepreneurs report that NHS Clinical Commissioning Groups either do not require or will not allow publication of results from pilot studies they sponsor. This poses a problem because institutions such as NICE typically prefer to base decisions on clinical evidence of value in the NHS.
The US has seen much progress in developing evidence through both observational and randomised trials, enabling practical assessment of app quality from both patient and provider perspectives. Progress is also being made in the UK, where the NHS Apps Library (https://apps.beta.nhs.uk) lists 46 apps that have successfully navigated the new Digital Assessment Questions (DAQs) to secure an endorsement as “trusted apps” for use by patients and clinicians. Other promising steps include publication of privacy and security guidelines (in the form of the DAQs), programmes such as the NHS England Innovation and Technology Tariff to address patient access, efforts to align digital health programmes with providers’ incentive structure, and interoperability initiatives to integrate apps into the physician workflow.
Patients in the UK are expressing interest in mobile health, with one survey finding that 36% of patients use health apps, and a second survey showing that 97% of 100 UK adults wanted the NHS to provide access to digital health technologies, including the ability to book mobile app video appointments. There remains scope to build enthusiasm from the UK payer and provider sides, based on the availability of tools and evidence, to transform the way care is delivered and value is provided to patients in a highly cost-effective manner.