Advice
The technology
The technology
QbTest (Qbtech Ltd) can be used to aid the assessment of attention deficit hyperactivity disorder (ADHD) and for evaluating different treatments in people with ADHD. It uses an infrared tracking system and computerised tasks to assess concentration, movement and impulsivity using age- and gender-matched comparisons.
The components of the test include an infrared tracking camera and stand, a flexible headband and reflective ball, a computer and a response button. The person doing the test uses the response button to complete a computerised task, while wearing the headband and reflective ball. The infrared tracking camera records the movement of the reflective ball. The test takes between 15 and 20 minutes. The results are analysed within minutes of the test being completed and are interpreted by a qualified physician.
Innovations
QbTest combines a continuous performance task with an objective and standardised measure of motor (physical) activity. This combination is innovative.
Current care pathway
ADHD is a neurodevelopmental disorder that is characterised by symptoms of hyperactivity, inattention and impulsivity that interfere with daily and occupational functioning.
ADHD is diagnosed by an appropriately qualified professional, such as a specialist psychiatrist or paediatrician. The diagnosis is made based on all of the following:
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a full clinical and psychosocial assessment of the person, including a discussion about behaviour and symptoms in different settings
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a full development and psychiatric history
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observer reports and assessment of a person's mental state.
The diagnosis process also involves assessing a person's needs, coexisting conditions, social, familial, educational or occupational circumstances and physical health.
A person is diagnosed with ADHD if, after the completion of all assessments, they meet the DSM‑5 criteria for ADHD, in that the person presents with symptoms of hyperactivity, inattention and impulsivity that negatively affect their life in 2 or more settings, such as school, work and home, and the symptoms have persisted for 6 months or more. People of any age can be diagnosed with ADHD.
After a diagnosis, people with ADHD and their families are given advice about how the diagnosis could affect them and where they will find useful information. Treatment for ADHD includes pharmacological and non-pharmacological interventions and depends on the person's age, symptoms and preferences.
NICE's guideline on the diagnosis and management of ADHD is relevant to this pathway.
Population, setting and intended user
QbTest is intended for use in people that have been referred for an ADHD assessment. It is used in addition to the assessments that make up standard care. QbTest is also indicated for use as an aid in the evaluation of treatment effect in ADHD.
It is done by a qualified healthcare professional who has been trained in the use of QbTest.
Costs
Technology costs
The total cost per assessment in England is between £23 and £96 (excluding VAT) depending on the test volume. This is in addition to standard care. No other costs can be provided at this time due to commercial sensitivity.
Costs of standard care
Costs of standard care vary depending on specific local processes for diagnosis. An average cost of £700 per case of standard care was determined from a Kent, Surrey and Sussex cost–benefit analysis and national programme evaluation report.
Real-world evidence demonstrator projects saw a cost reduction of between 9% and 39% depending on model implementation, as well as a return on investment between £14,300 and £93,000 when QbTest was used.
Resource consequences
QbTest is being used at 131 sites across 65 NHS trusts. The use of QbTest could improve the efficiency and speed of ADHD diagnosis as well as reduce assessment costs without loss of diagnostic accuracy. This may lead to an improvement in patient access to treatment.
Despite the test being used in addition to standard care assessments, real-world evidence suggests adoption of the technology in the ADHD assessment pathway reduces clinician assessment time by 20% to 30%. Consultation rooms will need very little adaptation for this technology, and healthcare professionals will need to be trained to use the test.