Care pathways combining digital therapeutics and conventional care for musculoskeletal disorders: State sequence analyses of 4-year claims data.

Background: Digital therapeutics (DTx) are promising for treating musculoskeletal disorders (MSD) which contribute significantly to global disability. Despite full reimbursement of certified DTx in Germany and other countries, their utilization remains low, mainly because of uncertainty about how to integrate DTx best into standard patient care. Objective: Using four years of claims data, this cohort study employs state sequence analysis to describe the claims-documented use of DTx in combination with other therapies and the influence of different care pathways on the change of chronicity risk over time. Methods: Health claims data of 6090 DTx users from one of the largest German sickness fund were analyzed (2020-2023). First, three treatment events were classified: outpatient consultations, medication prescriptions, and conventional physical therapy. Second, hierarchical clustering based on patient pathways was performed. Third, associations between clusters and the change of the patients' pain chronicity risk over time (improved vs worsened/equal) were analyzed via binomial logistic regressions. Results: We identified distinct patient clusters and showed that older and more severe cases were more likely to receive more healthcare services in addition to DTx. Prescriptions of additional pain medications (OR = 2.16, 95% CI: 1.63-2.84, Conclusion: This study emphasizes the need to individualize the prescription of DTx and supplementary treatments based on patient age and complexity. The combination of DTx and conventional care is especially promising for patient groups with high pain chronicity risks.