Digital therapeutics to boost adherence

The economic burden of chronic diseases is rising across the globe. Treatment outcomes of such diseases get highly influenced by early diagnosis and prescription of effective therapy by the physicians. However, another factor that often gets overlooked, is the motivation of patients for adherence to prescribed medications.

Non-adherence is a pharmaceutical company’s albatross. It is known to have negative health-related and economic consequences. These include poor quality of life, frequent episodes of hospitalisation and untimely mortality.

The socio-economic burden on the individual and the society greatly increases due to these consequences. It is not only the patient who suffers; the effect cascades to healthcare providers, physicians and the pharmaceutical company engaged in the research and development of the medication or therapy.

It is estimated that non-adherence to medication prescriptions may be contributing to treatment failures to the extent of 30% to 50%. Despite the availability of efficacious medical treatment options, nearly 50% of the medication prescriptions for chronic diseases may not be adhered to as prescribed.

Globally, the revenue loss for pharmaceutical companies due to non-adherence may be $564 billion, or 59% of the total pharmaceutical revenue. This may just be the tip of the iceberg with actual losses amounting to much more. Non-adherence may lead to an effective drug being labelled as ineffective and may even lead to withdrawal of the drug from the market.

Adherence to medication prescription gets influenced by a variety of factors.

Patient-related factors: health literacy, experience of side effects of medication, forgetfulness, personal beliefs, motivation

Physician and provider-related factors: ease of communication, physician interpretation of the medication guidelines, limited formularies

Economic factors: barriers of cost or affordability

Nature of therapy: complexity of dosing schedule, duration of treatment etc.

Nature of disease: severity and frequency of symptoms, ailments affecting mental status

So, what is the handwriting on the wall? The West is moving towards innovative reimbursement models like pay for performance and risk-reward pricing. It won’t be long before payers and financers in India, too, start following similar practices. Pressure from the regulators and payers towards provision of real-world evidence will also act as a driver for adoption of adherence improvement strategies.

For now, the pharmaceuticals are focused on merely monitoring adherence. The medication adherence data may not be sufficient for all products in the company’s portfolio. Addressing the problem of non-adherence and resolving its root causes will be seen as an important element of the market strategy of pharmaceuticals of the future.

In the past, many different tactics and strategies to increase medication adherence have been tried by pharmaceutical companies. These may target the patient, provider or address the external factors like affordability that affect adherence. However, it is now widely believed that adherence is primarily based on consistent behavioural changes; thus, the most effective methods for improving adherence involve patient engagement.

Clinic-based coaching has been considered to be a preferred model. Unfortunately, a therapist or a counselor cannot be with a patient all through the day and has a high cost per patient. An ageing population and a low ratio of healthcare professionals call for digital tools that perform the role of a coach or a therapist to make it easy and persistently nudging patients towards establishing the desired habits and adherence.

Advancements in health technology can now help pharmaceutical companies to partner with technology firms to build customised health coaching programmes in combination with their therapeutic products to deliver “digital therapeutics”.

The patients benefit from an ongoing caregiver education that is not limited to the physician’s office, but extends into their lives, thereby creating a deeper impact on sustainability of a therapeutic plan.

Digital therapeutics also help in improving long-term outcomes by remote monitoring. Depending on the disease, it is possible to motivate the patients to adhere to the advised diet and exercise programmes or their drug intake regimes. With digital therapeutics, tailor-made programmes can be delivered for diseases like diabetes, chronic obstructive pulmonary disease, hypertension etc.

Digital therapeutics are ideally suited for collating real-world evidence owing to its ability to reach large segments of population at risk, ease of tracking and analysis of a huge amount of data and low cost.

(The writer is co-founder and CEO and Wellthy Therapeutics)