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    Are the summaries of clinical and cost effectiveness reasonable interpretations of the evidence?

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The content on this page is not current guidance and is only for the purposes of the consultation process.

Guidance assessment consultation document for GID-HTE10020 Digital health technologies to help manage symptoms of psychosis and prevent relapse: early value assessment

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1 Recommendations

Adults

1.1

Three digital health technologies can be used in the NHS while more evidence is generated, to help manage symptoms of psychosis or prevent relapse for adults. The technologies are:

  • AVATAR Therapy, for managing auditory verbal hallucinations (hearing voices)

  • SlowMo, for managing distressing thoughts or paranoia

  • CareLoop, for monitoring symptoms of psychosis to prevent relapse.

These technologies should be delivered or supported by a mental health professional trained in the technology. They can only be used once they have appropriate regulatory approval and meet standards within NHS England's Digital Technology Assessment Criteria (DTAC).

1.2

The companies must confirm that agreements are in place to generate the evidence (as outlined in NICE's evidence generation plan) and contact NICE annually to confirm that evidence is being generated and analysed as planned. NICE may withdraw the guidance if these conditions are not met.

1.3

At the end of the evidence generation period (3 years, or sooner if enough evidence is available), the companies should submit the evidence to NICE in a form that can be used for decision making. NICE will review the evidence and assess if the technologies can be routinely adopted in the NHS.

Children and young people

1.4

More research is needed on using the following digital health technologies to help manage symptoms of psychosis or prevent relapse for children and young people:

  • AVATAR Therapy, for managing auditory verbal hallucinations (hearing voices)

  • SlowMo, for managing distressing thoughts or paranoia

  • CareLoop, for monitoring symptoms of psychosis to prevent relapse.

1.5

Access to the technologies for the population and indications in section 1.4 should be through company, research, or non-core NHS funding, and clinical and financial risks should be appropriately managed.

Evidence generation and more research

1.6

Evidence generation and more research are needed on:

  • change in the symptoms targeted by the technology, including longer-term benefits and who may benefit most from using these technologies

  • rates of relapse or worsening of symptoms, including patient safety monitoring, frequency and effectiveness of continued or repeated use

  • effect of the technology on functional outcomes, including social functioning and personal recovery (for example, the person's perception of how they are feeling)

  • intervention-related adverse events

  • resource use, including healthcare professional grade and time needed to deliver treatment or support

  • implementation and training costs associated with the use of the technology in the clinical pathway

  • resource consequences associated with relapse such as hospitalisation

  • adherence, including frequency of use and completion rate.

Potential benefits of early use for adults

  • Access: Access to psychological interventions for psychosis, such as cognitive behavioural therapy for psychosis (CBTp), varies and is very limited for some people. Digital health technologies for managing symptoms of psychosis offer another option for adults with psychosis who may otherwise not have psychological interventions. Technologies for monitoring symptoms may detect early signs of relapse, which could allow quicker access to treatment when needed.

  • Clinical benefit: Clinical evidence suggests that digital health technologies may improve symptoms of psychosis or prevent relapse in adults.

  • Resources: AVATAR Therapy and SlowMo may use less staff resources and time than CBTp. CareLoop may enable earlier treatment, which could reduce hospitalisations and demand on crisis intervention services.

Managing the risk of early use for adults

  • Clinical assessment: Digital health technologies should only be offered after assessing symptoms of psychosis and if the technology is suitable for the person. Some people may choose not to use digital health technologies and may prefer another treatment option. Everyone has the right to make informed decisions about their care.

  • Clinical support: Digital health technologies must be delivered or supported by a mental health professional trained in the technology. This includes monitoring and managing the safety of patients and their progress. This means that worsening of symptoms can be identified quickly and appropriate action taken.

  • Costs: Early results from the economic modelling show that the technologies could be cost effective. But there is considerable uncertainty because of the limited evidence. This guidance will be reviewed within 3 years and the recommendations may change. Take this into account when negotiating the length of contracts and licence costs.

  • Equality: Digital health technologies may not be accessible to everyone. Additional support and resources may be needed for people who are unfamiliar with digital technologies or who do not have access to the internet. This may be particularly important for people from ethnic minority backgrounds or from areas of high socioeconomic deprivation. Other treatment options may be more appropriate for some people.