Digitally enabled therapies for adults with depression: early value assessment

Space from Depression can be used as a treatment option for adults with depression while further evidence is generated on its clinical and cost effectiveness. It should be used with support from a trained practitioner or therapist in NHS Talking Therapies for anxiety and depression services. The technology can be used once it has Digital Technology Assessment Criteria (DTAC) approval and an NHS Talking Therapies for anxiety and depression digitally enabled therapies assessment from NHS England.

As the guidance is an early value assessment, the resource impact tools are not directing organisations to assess the cost of a full rollout of this technology. If there is an unmet need, this technology could be a solution. Organisations may therefore wish to identify the potential resource impact.

The prevalence of depression of adults in England is 6.7 million which is more than 15,000 people per 100,000 population. Each year an estimated 2.7 million adults will experience an episode of depression (NICE, 2022). An estimated 453,000 people are referred to NHS Talking Therapies for depression annually (IAPT, 2022). Under-treatment of depression is widespread, because many people are unwilling to seek help for depression and detection of depression by professionals is variable.

Standard care is the comparator and is the treatment offered for a new episode of less severe depression or more severe depression as described in sections 1.5 and 1.6 in NICE’s clinical guideline on depression in adults: treatment and management. These treatments are delivered by NHS Talking Therapies for anxiety and depression services.

Digitally enabled therapies are an alternative mental health treatment that can provide better access to care. Some mental health support teams will already be aware of and using this technology, however practice is likely to vary across different settings.

The economic modelling on Space from Depression showed that it could be a cost-effective option for people with less severe depression. The results showed that generic computerised cognitive behavioural therapy with support could be a cost-effective option for people with more severe depression. But the technology is less likely to be the most cost-effective treatment option when compared with other standard care treatment options.

Figures below outline an estimated capacity impact per 1,000 patients using indicative time. Please note these may vary by practice or therapy provided by standard care.

• We estimate that therapists need to be provide around 1,200 hours of contact time per 1,000 patients.
• In standard care we estimate that therapists need to provide around 8,000 hours of contact time per 1,000 patients equivalent to 8 hours per patient. This is based on all patients having less severe therapy treatments.
• Assuming outcomes are equal this provides a capacity benefit of circa 6,800 hours equating roughly to over 4 whole time equivalents (WTE’s) saved per 1,000 patients.

Where this approach to helping adults manage their condition is adopted, it may require additional resources to implement, which may be significant at a local level. Benefits derived from using Space from Depression may help mitigate additional costs.

Due to a lack of robust data on current practice and other variables such as whether digitally enabled therapies are an appropriate treatment option, the size of the resource impact will need to be determined at a local level. A local resource impact template has therefore been produced to assist organisations estimate the resource impact.

Depending on current local practice, areas which may impact resources include:

• Software costs of the technology.
• Capacity to deliver the guided element is needed from trained practitioners in NHS Talking Therapies for anxiety and depression services.
• Time required for training to support.
• Other costs such as IT equipment may be needed for those who do not have access to smartphones, tablets, or a computer.

Implementing the guidance may:

• Reduce waiting times and improve access to care in a timely manner. Early intervention may reduce the need for more intensive treatment later.
• Improve access to mental health services by offering greater flexibility, more choice and self-management through remote online interventions. Key considerations on the value of digitally enabled therapies are usability, ability to engage with users and effectiveness when compared with standard care.
• Better health outcomes and care experience.
• There may be some reduction in the requirement for supporting standard care from mental health teams. This can be assessed locally in the template.

Services for people with depression are commissioned by integrated care boards. Providers are NHS mental health trusts, third sector organisations and commercial providers.