The case for pharma to take the lead in health technology
Are there opportunities for pharma to apply industry expertise in the immature but promising digital health space? Tools and strategies backed by clinical data are already achieving reimbursement in the US. Dr Kristin Shine explores in pharmaphorum's health technology themed month.
When I was in medical school, a senior clinician told me medicine is easy – you just figure out what's wrong with people and then you fix it. I had always thought of the biopharmaceutical industry in a similarly simplistic way – you just develop drugs that work and then you market them. Clearly, both of these views need updating in an era where R&D productivity is declining and poor health outcomes are more likely to be determined by behaviour than by anything else, so what is the role for pharma in this changing health landscape?
According to the World Health Organisation, the top three threats to our health across countries and incomes are high blood pressure, tobacco use and high blood sugar1, risk factors that are primarily determined by lifestyles and behaviours. There is no lack of medications aimed at these chronic risk factors, but so far pharma has had limited involvement in the growing digital health space that has the potential for additional innovative tools to help us manage these 'modern risks.'
Translating current approaches into new opportunities
The industry has already started moving towards using digital health strategies in clinical research for a number of good reasons. Mobile-enabled clinical trials have the potential to improve patient recruitment and retention, allow access to real-time data, and reduce costs and resources associated with data collection, storage and analysis.
But these opportunities aren't unique to clinical trials. They translate to real-world patient management needs and could be developed into reimbursable products and services.
Technology companies have already started using pharma industry approaches to improve patient retention in healthcare routines, allow access to real-time data and translate data into actionable insights for both patients and providers. WellDoc's BlueStar programme is the first FDA-cleared mobile prescription therapy for diabetes2 and the company has achieved insurance and employer reimbursement3 by adopting a pharma evidence strategy model.
Last year the New York Times noted WellDoc's evidence-based approach and the resulting reimbursement levels: "WellDoc says that in a clinical trial, DiabetesManager was shown to reduce significantly the blood sugar levels in diabetes patients. Those results persuaded the Food and Drug Administration to give the system clearance to operate as a medical device. At over $100 a month, the cost is more akin to diabetes drugs than to most smartphone apps."
The costs of chronic conditions are dominating healthcare spending and the opportunity for return on investment for digital tools in chronic disease management is starting to come into focus, so who will lead the way? Technology companies or pharma?
Technology vs pharma – who should lead in digital health?
At the moment, technology is taking the first steps, but no industry understands the relationships between patients, providers and payers better than pharma. Additionally, pharma's expertise in clinical trials, regulatory navigation and data analysis perfectly position the industry to develop and market meaningful digital products either as adjuncts to existing therapies or as standalone services, such as WellDoc's diabetes platform. At a time of declining R&D productivity combined with pressures from payers for real-world data and outcomes-based reimbursement, expanding patient support to include digital tools could add additional marketable products to struggling pipelines.
Missing pieces
Pharma's expertise in specific health conditions is underpinned by academic and government funded research. The biggest gap in any industry being able to develop evidence-based digital strategies surrounds lack of research funding into behaviour change. According to Darzi review and the Cabinet Office 'less than 0.5 per cent of medical research spending was directed at behavioural factors4.' With better evidence for digital solutions enabling real-time actionable feedback and influencing behaviour change, the case for investment and reimbursement will become even more clear.
One area where pharma could have a significant near-term impact would be in stress and anxiety. A recent study published in the Journal of Psychopharmacology estimated anxiety disorders cost the UK nearly £10 billion per year5. Prescriptions for benzodiazepines and antidepressants, two main drug classes commonly prescribed for the treatment of anxiety, have risen sharply since the start of the financial crisis along with hospital admissions and outpatient appointments for anxiety6. Several opinion leaders have expressed concern about this trend, but healthcare providers have few robust, tangible options to recommend to patients apart from pharmaceuticals. Patients and providers would both benefit from a digital health product designed to help patients understand and manage anxiety triggers, supported by evidence-based non-pharmacological interventions such as deep breathing and mild exercise.
If healthcare providers could recommend a comprehensive platform to help patients manage stress and anxiety, they could feel more comfortable prescribing this tool in place of or in conjunction with pharmaceuticals aimed at tackling stress and anxiety. And it would make sense for a pharma company to offer both products. As an MD, I would feel most comfortable recommending a programme grounded in physiology and evidence, backed by efficacy data and developed with the rigours of pharma. As an entrepreneur in this space, I see the opportunity to demonstrate return on investment and translate such programmes into reimbursable products.
References
1. http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf
5. http://www.ecnp.eu/~/media/Files/ecnp/communication/reports/ECNP%20EBC%20Report.pdf
About the author:
Dr Kristin Shine is a science communications specialist. She is currently the Chief Medical Officer of BioBeats, a healthcare technology startup merging entertainment and healthcare to keep people engaged in health and wellness routines. She also runs a boutique life science communications consultancy and is currently working with members of the European Academies Science Advisory Council (www.easac.eu/) on the Smart Villages Initiative, providing science-based guidance on rural development issues in Africa, Latin America and Asia.
Kristin received her undergraduate degree in Molecular Biology from Princeton University and went on to study clinical medicine at Columbia College of Physicians and Surgeons in New York City where she received her Doctor of Medicine degree with honours in Internal Medicine, Pediatrics, Psychiatry and Primary Care. Working in Columbia's network of hospitals, she gained first-hand experience across a broad range of specialties, built a diverse network of medical relationships, and was recognised with the Palatucci Prize for excellence in patient care.
After obtaining her MD, Kristin joined Brunswick Group, one of the UK's leading corporate communications firms, to advise pharma, biotech and medtech clients on digital strategy, corporate reputation, thought leadership and stakeholder engagement. In her time with Brunswick, she worked with a wide range of clients including AstraZeneca, Pfizer, Amgen, McKesson, Vernalis and Consort Medical and helped build Brunswick's digital practice.
Kristin can be contacted at kristin.shine@gmail.com
Closing thought: Are there opportunities for pharma to apply industry expertise in the digital health space?
