NHS Talking Therapies for anxiety and depression is a service that provides people in England with psychological support. There are several referral routes into the service, digital front door technologies being the most recent addition. The aim of this National Institute for Health and Care Excellence early value assessment was to map available evidence, assess potential benefits and costs of NHS Talking Therapies referral pathways with and without digital front door technologies, and identify evidence gaps to help direct future data collection and further research. The External Assessment Group carried out a systematic literature review (December 2024) to gather evidence relating to Limbic Access (Limbic), Wysa Digital Referral Assistant (Wysa), Censeo Digital (Psyomics) and AskFirst (Sensely). Information was collected across four broad outcome categories: accuracy and acceptability, resource and system impact, patient-reported outcomes, and costs. All study types were eligible for inclusion in the systematic literature review, along with evidence provided by the manufacturers of digital front door technologies (via requests for information). In addition, the External Assessment Group interviewed and sent questionnaires to stakeholders, including National Institute for Health and Care Excellence Specialist Committee Members, and carried out exploratory analyses of costs and benefits. Evidence was only available for two digital front door technologies: Limbic Access and Wysa Digital Referral Assistant. Literature meeting the systematic literature review eligibility criteria comprised two published peer-reviewed studies, six unpublished studies and five requests for information responses. The strongest evidence related to accessibility and overall satisfaction with Limbic Access. Results from one peer-reviewed study showed that Limbic Access increased the number of referrals to NHS Talking Therapies versus services that did not implement the technology (odds ratio = 1.10, 95% confidence interval 1.075 to 1.131); this included an increase in access for some minority groups [Asian (odds ratio = 1.29; confidence interval 1.163 to 1.422), Black (odds ratio = 1.35, confidence interval 1.183 to 1.551) and non-binary (odds ratio = 2.95; confidence interval 2.065 to 4.206)]. Overall satisfaction reported by users who completed the Limbic Access referral process was high (≥ 89%). Resource impact evidence was provided by one peer-reviewed study; results showed that Limbic Access reduced clinical assessment duration by 12.7 minutes. No relevant information on quality and accuracy was identified. Respondents were positive about digital front door technologies, suggesting that these tools could lead to better quality and more accurate (1) pre-referral practices and (2) initial clinical assessments; however, experts were unable to clearly define quality or accuracy. The External Assessment Group's exploratory economic analysis results suggested that the amount of clinical assessment time required to notionally offset the Limbic Access or Wysa Digital Referral Assistant licence cost was small (< 3 minutes). Most published evidence was non-comparative. The strength of the evidence provided by the technology companies was difficult to assess due to limited detail. Further evidence is required to better understand the benefits and costs of digital front door technologies for NHS Talking Therapies. Evidence generation should focus on whether digital front door technologies improve the accuracy and quality of clinical assessments and their impact on resources throughout the referral pathway. This study is registered as PROSPERO CRD42025634844. This award was funded by the National Institute for Health and Care Research (NIHR) Evidence Synthesis Programme (NIHR award ref: NIHR171847) and is published in full in Health Technology Assessment; Vol. 30, No. 52. See the NIHR Funding and Awards website for further award information. NHS Talking Therapies provide psychological support to people in England who have anxiety and depression. There are different ways to access these services, and one of the newest methods is by using digital front door technologies. Digital front door technologies are digital tools that gather relevant information (with or without the use of artificial intelligence); they are intended to make the NHS referral process quicker and more efficient. This research explored the potential benefits and costs of using digital front door technologies. An independent research team reviewed published and unpublished evidence, collected information from the companies that created the technologies, and interviewed experts. Robust evidence was lacking for the impact of digital front door technologies on four key outcomes: quality and accuracy of the data collected using digital front door technologies, accuracy of the clinical assessment, impact on administrative burden and time taken to review data collected by digital front door technologies. There was some evidence about the effectiveness of two digital front door technologies (Limbic Access and Wysa Digital Referral Assistant). The Limbic Access evidence was more robust than the Wysa Digital Referral Assistant evidence, particularly in terms of accessibility outcomes; Talking Therapies services that used Limbic Access experienced a larger increase in the number of referrals than services that did not implement Limbic Access. Digital front door technologies were associated with high levels of user satisfaction and may help save time during the initial clinical assessment. None of the evidence reported any harms associated with the adoption of the Limbic Access and the Wysa Digital Referral Assistant digital front door technologies. The adoption of digital front door technologies may provide value for money for the NHS. For the technologies to be considered to provide value for money, < 3 minutes of clinical assessment time need to be saved or the technologies need to provide a very small gain in patient quality of life. Experts were generally positive about using digital front door technologies and felt the technologies could improve the quality and accuracy of referrals to NHS Talking Therapies. However, the experts could not clearly define what ‘quality’ and ‘accuracy’ meant in clinical practice. Overall, while findings are positive, more research is needed to fully understand the benefits, costs and impact of using digital front door technologies to access NHS Talking Therapies.
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