Could Unmet Need in Insomnia Present an Opportunity for Digital Therapeutics?
Insomnia, a condition afflicting more than 30M Americans that KOLs generally prefer treating with CBT-I (CBT for insomnia) alone (to avoid the side effects of pharmacotherapy while also providing more durable benefit) is ripe for digital intervention. CBT-I is generally inaccessible to many insomniacs owing to a documented lack of specialists and other structural, physical, and behavioral barriers. DTx has the potential to overcome these barriers by delivering CBT-I digitally. Moreover, DTx may have several advantages from a patient perspective compared to traditional CBT-I, including increased scheduling flexibility, more discrete treatment, and enabling data-driven treatment iterations.
Sleep disturbances are associated with accidents, a loss of workplace productivity, and increased health care costs. It's estimated that US workers lose 7.8 days of work annually because of insomnia, which translates to a loss in human capital value of $91.7 billion.
Insomnia is often a persistent condition, with more than half of patients maintaining their diagnosis after five years. Insomnia is often intertwined with other comorbidities, such as MDD, anxiety, and chronic pain conditions, and is associated with significant losses in productivity and increases in health care costs. Lack of access to CBT-I leads to many patients being treated via pharmacological interventions that are often not as effective, bring inherent safety concerns, and yield frequent off-label prescribing.
DTx is likely approaching an inflection point, as many providers and payors have been reluctant to adopt and pay for digital solutions to mental health conditions owing to the modality's novelty and a lack of clinical/real-world data demonstrating benefit. However, digital health approaches have received more attention in recent years, especially in the wake of the COVID-19 pandemic. DTx solutions are increasingly investigated through randomized controlled trials, some of which have improved patient outcomes. Moreover, KOL feedback indicates enthusiasm for a more flexible and discrete treatment approach. DTx also supports payors’/regulators' priorities to move care upstream to prevent hospital visits. And while we see the potential for broad adoption, the rate of payor, provider, and patient acceptance may hinge on the generation of real-world data and analysis of its impact on reimbursement dynamics.