Title: Costs and Outcomes of Digital Interventions to Promote and Improve Mental Health: Evidence Review and Synthesis, Decision Modelling and Knowledge Transfer
Funder: Department of Health and Social Care

Abstract: Digital mental health interventions (DMHIs) use software programmes accessed via computers, smartphones, audio-visual equipment and other devices, to deliver interventions that aim to prevent and improve mental health problems, such as depression, anxiety, addiction and eating disorders. NHS investment on digital technologies is growing. This is particularly important for mental health care where access to services is limited and face-to-face contact with psychiatrists and psychologists is at a premium. Potential investment in digital technologies is large and irreversible, so we need to understand under what circumstances these technologies are conducive to efficient and effective delivery of mental health care and the degree of certainty about the conclusions regarding their cost-effectiveness. Hundreds of clinical studies provide evidence of improved outcomes with DMHIs, especially for common mental health problems, such as depression and anxiety disorders, but also for addictive behaviours and eating disorders. Economic evaluations (EEs) can provide evidence as to whether DMHIs are good value for money, based on their costs and outcomes relative to the costs and outcomes of alternative care options. No review has so far given a comprehensive picture of whether DMHIs are “good value for money”, across all populations, technologies and interventions, especially in the long-term. Our main aim is to identify and summarise all published and unpublished economic studies comparing the costs and outcomes of DMHIs to the costs and outcomes of alternatives (e.g. interventions without digital technologies or no intervention). We will also develop a taxonomy for categorising DMHIs. Finally, we will explore how economic and clinical evidence is understood and used by key stakeholders in making decisions about the future development, evaluation and adoption of such interventions. In a collaboration between the Centre for Health Economics, the Centre for Reviews and Dissemination and the Department of Health Sciences at the University of York, we will deliver an 18 month project with 4 work-streams (WS). - WS1 is a systematic review, critical appraisal and narrative synthesis of all available economic evidence on DMHIs. - WS2 is a systematic review, narrative synthesis and, when appropriate, quantitative analysis of RCTs and observational studies for a sub-set of DMHIs where the most and best quality clinical evidence exists but without matching economic evidence. - WS3 considers an economic modelling exercise that quantifies the short- and long-term cost-effectiveness of selected DMHIs followed by a value of information (VoI) analysis, using data from WS1 and WS2. - WS4 is a series of knowledge exchange workshops with four groups of stakeholders where we will communicate our findings and explore how each stakeholder group understands, interprets and may potentially use these findings. Apart from peer-reviewed publications and a HTA report, our project will produce a step-by-step guide and an assessment checklist specific to EEs of DMHIs. We will also produce evidence briefings and a proposal for improving science communication with different stakeholder audiences to help them make sense of economic evidence and use this evidence to make decisions about DMHIS within a resource constrained system like the NHS.

Lay abstract: Digital mental health interventions (DMHIs) use technologies such as computers and smartphones to provide interventions, like psychological therapies, to those who want to promote or improve their mental health. For example, there are software programmes that deliver cognitive behaviour therapy (CBT)for depression without the need to speak to a therapist, or virtual reality systems that produce exposure therapy scenarios to treat phobias and post-traumatic stress disorder. There is a vast number of research studies evaluating DMHIs for different conditions and with different groups of people. We know that many DMHIs can improve mental health problems as much as, or more than, existing care options that do not involve digital technologies. For example, randomised controlled trials and systematic reviews demonstrated that psychological therapies via a computer could be as good as seeing a therapist face-to-face. Many of the arguments in favour of DMHIs are financial: using technology allows therapists to see more people in a given period and to deliver treatment and collect information remotely, which could potentially save time and money. Economic evaluations can provide evidence as to whether DMHIs are good value for money, not only based on their costs but also based on their outcomes. Surprisingly, the number of economic evaluations available is only a small fraction of all the research studies evaluating DMHIs, because most of these studies focus on outcomes. DMHIs are expensive and we need to know whether a potential investment is worth it for the patients and for the health service. An efficient way to do is to take stock of all the existing economic evaluations of DMHIs by conducting a review and organising all the available information into tables and succinct summaries. Because economic studies of DMHIs are either non-existent for some populations, or only look at short-term cost-effectiveness, or are of poor/moderate quality, we will review and collate the best quality clinical evidence to construct an economic model that tells us whether DMHIs could potentially be a good return on investment for specific conditions long-term. To conduct our reviews, we will search a wide range of literature sources for existing economic studies of DMHIs. We will then screen these studies for relevance and methodological quality. We will present our results in tables according to the types of conditions for which DMHIs were used (such as depression, psychosis, anxiety), the types of interventions used (for example cognitive behaviour therapy, interpersonal therapy, medication management) and the different modes of delivery (such as web-based or via a smartphone). We will pool together clinical outcomes using advanced statistical methods and narrative descriptions to inform our decision modelling. Finally, we will present our results to different groups of people, including service users, mental health professionals and technology experts, and discuss how they understand our findings on the costs and outcomes of DMHIs and how our findings can inform their decisions to potentially use, fund or further develop DMHIs. Service user representatives, academics and clinicians will make up an expert reference group who will guide the research team on all aspects of the evidence collection and synthesis, make recommendations and help disseminate the results via evidence briefings, publications, conferences and social media.

Research activity codes: 8.2 HEALTH AND WELFARE ECONOMICS
Health categories: MENTAL HEALTH