Digital Therapeutic for Substance Use Disorder Drives Down Care Utilization, Cost

Digital therapeutics firm Pear Therapeutics has released new data showing its prescription substance use disorder (SUD) therapy reduces hospitalizations and lowers healthcare costs for patients.

The data will be published in the journal Advances in Therapy, but the findings are currently available online as a pre-print.

The treatment is called reSET. The app is built around cognitive behavioral therapy (CBT) utilizing the community reinforcement approach (CRA), the company said. It includes a 12-week course of therapy, in which patients are incentivized for completing lessons and abstaining from drug use. The app also includes fluency training designed to reinforce the lesson content.

Previous studies have shown the therapy can be effective at improving rates of abstinence and treatment retention when coupled with usual treatments. In the new report, investigators wanted to know how such improvements might translate into changes in healthcare resource utilization and costs.

The investigators used claims data to identify 101 patients with SUD who had been prescribed reSET. The authors then evaluated healthcare utilization and costs for the patients in the six months prior to the start of reSET treatment and in the six months after starting the therapy. Most of the patients (54.5%) were on Medicaid insurance.

Overall, the data showed a 50% drop in hospitalizations among the cohorts once they started using reSET (incidence rate ratio [IRR]: 0.50; 95% confidence interval [CI]: 0.37-0.67; P<0.001). That included drops in inpatient stays, partial hospitalizations, and emergency department (ED) visits, the investigators said. Patients using reSET also had lower laboratory and pathology costs, the analysis showed.

All of that translated to an estimated $3,591 per patient reduction in healthcare costs in the six months following reSET initiation compared to the six months before beginning the therapy.

“Pear now has a continuum of evidence supporting our 3 FDA-approved prescription digital therapeutics, including randomized controlled trials, real-world clinical data, and real-world health economic data,” said Yuri Maricich, MD, Pear’s chief medical officer and head of development, in a press release.

Maricich said the data were also important because they make a case that prescription digital therapeutics can add value, even if they come at an additional cost to traditional therapeutic approaches.

Pear’s Neel Shah, BPharm, PhD, the study’s corresponding author, noted along with colleagues that the timing was also significant given that the study period of January 2018 to February 2021 included the COVID-19 pandemic era.

“Although hospitalization rates for certain disease states declined during the pandemic (e.g., acute cardiovascular disease and stroke/transient ischemic attack) several published datasets and analyses show that among patients with existing SUDs the rate of ED visits and hospitalizations increased during the pandemic,” the authors wrote.

Previous reports have suggested people with SUDs were more likely to be hospitalized with COVID-19 compared to people without a diagnosed SUD.

Shah and colleagues said their data set is subject to limitations. Costs were estimated based on published literature, and therefore might vary from actual costs. In addition, the data set did not allow for mortality analysis, so they said it is possible some patients might have died during the six-month period after initiating reSET.

Still, Shah and colleagues said the data suggest CBT administered through the reSET program may be an important treatment addition for many patients with SUD.

“The observed per-patient cost reduction of $3,591 in the pre-post analysis suggests that treating patients with reSET may lower overall costs of care, which may be relevant to payors at all levels of the healthcare system,” they concluded.