OBJECTIVES: Anxiety impacts over 40 million adults in the US, with many people delaying care which can exacerbate symptom severity. Digital Therapeutics (DTx) have been shown to reduce symptoms of anxiety. In order to quantify system-level impact of DTxs, an understanding of how anxiety severity impacts economic burden needs to be established. The study objective was to determine how anxiety severity levels can impact economic burden in adults over one year.

METHODS: We used 2019 US NHWS, a self-administered, online, nationally representative survey that collects health information. We queried adults aged 18+ with treated (TR_A) and untreated (UTR_A) (no anxiety-related pharmaceutical use (Rx) or therapy) anxiety. Endpoints were assessed by severity levels for anxiety GAD-7 (none (<5), Mild to Moderate (5-15), Severe (15-21)), GAD-2 (None (<3), Anxiety (3+)) and concurrent depression status with Patient-Health questionnaire (PHQ-9) (None (0-5), Mild/Moderate (5-15) and Severe (15-27)).

Direct medical costs (DC) were quantified by applying 2018 Medical Expenditure Panel costs to utilization endpoints (outpatient visits, hospitalizations, emergency department visits, and Rx). Indirect costs (Wages lost) were calculated by multiplying work days lost by the average daily wage (2019 US Bureau of Labor Statistics). Descriptive statistics were used to calculate mean and standard deviation of the DC and IDC; comparisons for costs of anxiety with versus without depression were done using ANOVA.

RESULTS: The mean DC and IDC for UTR_A for GAD-7 ranges: < 5 ($7,003) ($4,055), 5-15 ($11,827) ($7,473) and 15-21 ($41,482) ($10,172); GAD -2 ranges: <3 ($7,727) ($5,204), 3-6 ($25,280) ($8,972). Higher anxiety severity levels resulted in increased costs in TR_A group. Individuals with severe anxiety and severe depression drove the highest DC ($29,285 (TR_A), $47,013 (UTR_A)) and IDC ($10,881(TR_A), $11,140 (UTR_A).

CONCLUSIONS: High anxiety levels and co-morbid depression status was shown to increase costs. By improving symptoms of anxiety and depression, DTxs may reduce economic burden.