An independent analysis found virtual mental health solutions for depression and anxiety effectively treat the conditions, but they vary widely in their economic impact.
While some solutions could lower healthcare spending by a few million a year for commercial payers, the most commonly adopted solutions are driving up costs by $25.6 million per year, the Peterson Health Technology Institute (PHTI) found in a new report.
The PHTI is a third-party group that brings together payers, providers and vendors to assess the clinical evidence and economic impact of leading digital health solutions.
The virtual mental health solutions for depression and anxiety report is the PHTI’s fourth evaluation of digital health products since the start of 2024. It has previously reviewed market-leading solutions for diabetes, hypertension and musculoskeletal disorders.
Depression and anxiety affect about 1 in 5 adults and cost employers $240 billion per year in treatment costs and lost productivity, the report says. Research also suggests that for every $1 payers spend on mental healthcare, they gain back $4 in productivity.
The proliferation of virtual mental health treatments since the COVID-19 pandemic has expanded access to mental healthcare for millions of Americans. The PHTI’s report notes that investors have poured $10.2 billion into the sector since 2016, and many of these startups have reached unicorn status.
The group evaluated market leaders like AbleTo, Brightside, Headspace, Koa Health, Lyra, Meru Health, Modern Health, Spring Health, Teladoc and Talkspace, among others.
All of the digital solutions the PHTI evaluated for depression and anxiety had a positive impact on symptoms and produced clinically meaningful results, according to the PHQ-9 screening test for depression and the GAD-7 test for anxiety.
The PHTI evaluated 15 market solutions for virtually treating depression and anxiety. The solutions fall under three banners: self-guided solutions, prescription digital therapeutics and blended modality solutions. All virtual mental health treatment solutions it evaluated included a library of digital content that is accessible by patients at all times.
“The self-guided solutions are just standalone content libraries,” Caroline Pearson, executive director of the PHTI, said in an interview. “The prescription digital therapeutics are very similar in terms of the sort of user experience, but because they are prescribed, they are sort of inherently integrated into therapy … the blended care solutions are the most comprehensive, and they include virtual care teams that have therapists and other clinicians. That is really where most of the market is in terms of the size of contracts and purchasing and spending,” she said.
The chief difference the PHTI identified in its report is the pricing models of the solutions that made total cost vary dramatically.
The leading solutions on the market take a blended approach between digital provider visits and asynchronous content availability. On average, they cost payers $25.6 million a year per 1 million members because they charge an access fee for every member on the plan, the PHTI’s economic analysis found.
Self-guided solutions reduced spending by $3.6 million per year per million members. The digital content libraries are offered through health plans as wellness benefits or employee assistance plans.
Prescription digital therapeutics reduced spend by $8.7 million per million members when used in the course of treatment by a provider. The solutions have traditionally been sold to providers for roughly $200 to $400.
The virtual mental health solutions analyzed in the report had a dramatic impact for individuals who were not receiving other mental health treatment.
“Digital content is very clinically effective,” Pearson said. “I think that's a big takeaway, because historically, people think about great mental healthcare being a one-on-one conversation … what we see in this report is actually that a wide range of treatment modalities are clinically effective, especially for mild to moderate depression anxiety.”
When added to usual care like psychotherapy and medication, digital content-only solutions provided an incremental, non-statistically significant improvement in symptoms for depression and anxiety. However, patients experienced significant improvement in their symptoms when they were able to access digital content compared to receiving no treatment.
“For people without access to psychotherapy … digital content demonstrates more substantial clinical benefits than when added to usual care,” the report says.
That PHTI found that digital content users experienced a 3.9-point reduction in depression severity compared to the control arm, which received no treatment. Six of the seven studies PHTI reviewed demonstrated a clinically significant reduction in depression.
Only three studies compared the impact of digital content for anxiety to a control arm with no intervention. The three studies averaged a 2.1-point decrease in anxiety on the GAD-7 scale. Two of the three studies showed clinically meaningful impact.
“Given the significant barriers to accessing traditional psychotherapy … such digital content may help address a critical gap in mental healthcare delivery,” PHTI concludes.
Eight companies sold self-guided solutions. Three companies, Dario, Learn To Live and SilverCloud (Amwell), only sold digital libraries with evidence-based content, while the five other solutions sell stand-alone, self-guided solutions in addition to blended-care solutions, including Teladoc and Headspace.
The self-guided interventions include videos and activities based in cognitive behavioral therapy. Some had AI chatbots or other opportunities to asynchronously interact with providers or coaches. The solutions were largely purchased as replacements for employee assistance plans or wellness benefits, according to the analysis.
The prescription digital therapeutics are both FDA cleared to deliver cognitive behavioral therapy. Daylight Rx, owned by Big Health, treats anxiety, and Rejoyn by Otsuka Precision Health is cleared to treat depression. Because the technologies require a prescription by a provider who is managing the patient’s treatment, the PHTI noted that PDTs would not likely expand access to mental healthcare.
“Because they go through FDA clearance, they had some of the strongest, most well-designed clinical trials that we saw in this report, and so we feel pretty confident about the clinical benefits that those solutions offer,” Pearson said. She noted that while adoption of PDTs is low and reimbursement is uncertain, more therapists and primary care providers should be made aware of the cost-saving technologies.
While the self-guided solutions and the prescription digital therapeutics achieved cost savings for payers, the blended solutions increased costs by tens of millions, PHTI researchers said.
The 10 blended care solutions offered a digital content library alongside live or asynchronous therapeutic services by therapists and psychiatrists. The blended care solutions demonstrated that they could be the most clinically effective of the three solution categories, though they are also the most expensive.
“For people not receiving psychotherapy, the evidence suggests a blended care solution … produces better outcomes than self-guided tools alone,” the report says.
The blended care solutions—AbleTo, Brightside, Headspace, Koa Health, Lyra, Meru Health, Modern Health, Spring Health, Teladoc and Talkspace—charge employers a fee for every member in the plan, regardless of whether they use the product. At an average of $6 per member, the blended care solutions were projected to increase total healthcare spending by employers and commercial plans by $25.6 million.
According to anecdotes by payers, blended care solutions are the most widely adopted in the market, Pearson said. If the solutions were priced at roughly $4 per member, the offerings would be breakeven for payers, she noted.
PHTI recommends commercial payers be active negotiators in setting the price for blended care solutions to increase their cost effectiveness. Pearson also mentioned that getting more members to engage in blended care solutions could also justify the cost, though engagement is a perennial issue for payers.
The report notes that the blended solutions have the potential to scale up or down the intensity of intervention according to the needs of the patient. People with mild or moderate symptoms could lean more on the digital content library and asynchronous provider interactions, while people with moderate to severe depression and anxiety could use more hours of synchronous psychotherapy.
“Engagement is actually the critical question here,” Pearson said. “I think that's where we have a lot of work left to do … we see that digital tools are clinically effective across all demographic groups, old and young, women and men, all race and ethnicities, but it is young white women who disproportionately are drawn to using these tools … that's an area that I just think we haven't cracked yet.”