1 Recommendations

1.1

Seven digital technologies can be used in the NHS during the evidence generation period as options to support self-management of asthma. The technologies are:

Asthmahub
Asthmahub for parents
Digital Health Passport
Luscii
myAsthma
RDMP (Respiratory Disease Management Platform)
Smart Asthma.

These technologies can only be used:
if the evidence outlined in the evidence generation plan for technologies to support self-management of asthma is being generated
as long as they have appropriate regulatory approval including NHS England's Digital Technology Assessment Criteria (DTAC) approval.

1.2

The companies are responsible for ensuring that data collection and analysis takes place. They must confirm that agreements are in place to generate the evidence. NICE will contact the companies annually to confirm that evidence is being generated and analysed as planned. NICE may revise or withdraw the guidance if these conditions are not met.

1.3

At the end of the evidence generation period (3 years), the companies should submit the evidence to NICE in a format that can be used for decision making. NICE will review the evidence and assess if the technology can be routinely adopted in the NHS.

What this means in practice

These digital technologies can be used as options in the NHS during the evidence generation period (3 years) and paid for using core NHS funding. During this time, more evidence will be collected to address any uncertainties. Companies are responsible for organising funding for evidence generation activities.

After this, NICE will review this guidance and the recommendations may change. Take this into account when negotiating the length of contracts and licence costs.

Potential benefits of use in the NHS during the evidence generation period

Patient benefit: The technologies may support people to follow their personalised asthma action plan (PAAP) and could help them use their medicine and inhalers more effectively. The technologies can increase confidence in self-managing asthma and may improve communication with healthcare professionals, leading to improved asthma management.
Clinical benefit: Clinical evidence suggests that the technologies may improve asthma control, which could help reduce exacerbations and improve quality of life.
System and resource benefit: The technologies may improve asthma control, which could reduce hospitalisations and emergency department visits.
Equality of access: Digital technologies offer an alternative format to written PAAPs. Some people may find it easier to use digital technologies.

Managing the risk of use in the NHS during the evidence generation period

Costs: Early results from the economic modelling show that the technologies could be cost effective. But there is wide variation in the prices and costing mechanisms of the technologies and NHS trusts should take this into account when choosing a technology.
Patient outcomes: The technologies are not intended to replace clinical review. So, the risk from using them is low because people will still have regular reviews with healthcare professionals.
Equality: Some people may find it more difficult to use digital technologies and may need additional support. This includes people who:
- are less comfortable using digital technologies
- have limited access to hardware or the internet
- are neurodivergent
- have learning disabilities
- have problems with manual dexterity
- have visual or cognitive impairments
- have difficulty reading, writing or understanding health-related information (including people who cannot read English).

What evidence generation is needed

More evidence needs to be generated on:

clinical effectiveness, including:
- the long-term impact on outcomes such as exacerbations, asthma control and quality of life
- how effective the technologies are at improving self-management of asthma
- how effective the technologies are in the following subgroups:
  - adults (aged 17 and over), including families or carers
  - young people (aged 12 to 16) and children (aged 5 to 11), supported by families or carers
  - families or carers of children under 5
  - people with severe asthma
  - people with newly diagnosed asthma
- the additional value of connected devices, such as spirometers, peak flow meters and smart inhalers
rates of people both starting and stopping use of the technologies, and reasons for stopping use
the experience of people using the technologies, including ease of use and how comfortable people feel using them
healthcare resource use, including staff time.

The evidence generation plan gives further information on the prioritised evidence gaps and outcomes, ongoing studies, potential real-world data sources and generalisability of findings to NHS practice. It includes how the evidence gaps could be resolved through real-world evidence studies.

Why the committee made these recommendations

There is a high unmet need for effective self-management support for asthma control. Improving asthma control can reduce exacerbations and enhance quality of life.

Evidence on the clinical effectiveness of digital technologies to support self-management of asthma is limited, but studies suggest that the technologies may help to improve asthma control in the short term. People who have used the technologies report that they are easy to use and acceptable in terms of comfort and willingness to use. There are no reports of harm or adverse events from the technologies. The risk to people from using the technologies is considered low because they do not replace clinical review by a healthcare professional.

The long-term clinical effectiveness is uncertain. The studies are mostly observational and some have small sample sizes. So, more evidence is needed on the long-term impact of the technologies on important outcomes such as asthma control, exacerbations and quality of life.

Early results from economic modelling suggest that the technologies could be cost effective. But more evidence is needed on the impact of the technologies on clinical outcomes and the numbers of people who start and continue to use them.