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Digital Therapeutics: a new ‘class of medicine’

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Digital health solutions that work’: that is digital therapeutics (DTx), in a nutshell. Abhishek Shah, CEO and Co-founder, Wellthy Therapeutics, further shares his insights on the trend

‘Digital health solutions that work’: that is digital therapeutics (DTx), in a nutshell. DTx are not only a new category of care in the digital health landscape, but also a new ‘class of medicine’, because they help doctors treat, manage or prevent disease and have proven outcomes, just like pills!

For this reason, the market for digital therapeutics is expected to triple in size and become a $9 billion market over the next six years and the adoption of DTx is likely to increase 10-fold by 2031.

With DTx companies adopting a primarily B2B commercialisation model the world over, and pharma and insurance stakeholders adopting it whole-heartedly, it is now time for providers to integrate DTx efficiently into the current patient management paradigm.

What makes DTx unique?

Think of digital therapeutics as a journey – a journey that is all encompassing and covers all aspects of condition management. This journey is designed with the patient at the centre and is based on clinical recommendations specific to a chronic condition. It communicates with the patient in a manner that is tailored to their individual situation and forms daily habits that link daily improvement in actions to set health goals.

While brick and mortar set-ups have access limitations, DTx-enabled on-demand feedback loops, patient education and coaching, personalised to every patient that helps in completion of the care regimen. Layers of behavioural science, analytics and machine learning with continuous monitoring work synchronously to optimise, personalise and deliver sustainable care, even in the remotest parts of India.

But what truly sets digital therapeutics apart is that they have the real-world evidence to prove that they work. They can make a claim to bring about improved patient outcomes, and help in preventing, managing or treating a medical condition or disease. Various studies have proven time and again the ability of DTx to augment results from the existing standard of care.

How can DTx change the way these diseases are managed and treated?

  • The value of DTx for patients: The effectiveness of treatment for chronic diseases depends on two important factors- the efficacy of a drug or device and patient behaviour (including compliance). Behavioural changes involve adherence to the medication regimen, routine monitoring and self-care. However, this is easier said than done. Adherence is at a mere 33 per cent and more than 70 per cent Indians do not follow the recommended self-care behaviour. As a result, patient outcomes are affected and complications are on the rise. This is where DTx therapies best add value. DTx empowers patients with self-management tools and education to enable them to cope healthily with their condition. Positive nudges, real-time feedback, life hacks and routine outcome tracking help to create positive feedback loops and reinforces adherence to therapy.

    Furthermore, it is often months before patients follow up with their physicians, only to get a 10-minute consultation. And even during this consultation, they are unable to recall progress or ask all the questions they had planned to ask.

    Once again, here is where DTx can help. DTx allows personal progress to be documented with solutions offered in real-time. Having credible support during moments that actually matter can significantly improve patient satisfaction.

    Overall, DTx enables a holistic approach to patient care, above and beyond what our current care delivery infrastructure allows. This, in turn generates outcomes, which significantly improve quality of life.

  • The value of DTx for physicians: It is often months before patients follow up with their physicians. And treatment decisions are often based on patient recall, with minimal tracking and analysis.

    DTx serves as clinical decision support. With DTx, many data points are captured, ranging from triggers, to adverse events, to coping with episodes of strong medication impact, to the impact of food intake on overall biochemical parameters. With data tracked from multiple people, like patients, trackers, coaches and caregivers, doctors have better insight into underlying factors that may or may not cause conventional treatment to succeed. This data can be utilised to then titrate medication, which overall allows for a more accurate treatment. DTx also allows physicians to extend treatment beyond their clinic. Most doctors admit that their patients often need one-on-one counselling support and regular motivation to manage their condition. Unfortunately, they simply do not have the time to do this. A credible, proven DTx solution can fill these need gaps in our current healthcare infrastructure and improve the overall quality of care.

  • The value of DTx for pharmaceutical companies: The world is moving from clinical trial outcomes to real-world outcomes. The world is moving from pay-per-use care to value-based care. These movements put pharmaceutical companies in a tough spot, as they need to go further to influence real world outcomes at a per patient and population level to ensure market and value growth. In addition, adherence to medication is an established industry-wide challenge and impacts long-term outcomes tremendously.

    Pharmaceutical companies have been one of the largest adopters of DTx globally and in India. They can use DTx not only as a means to ensure medication adherence, but also as a method to improve overall treatment effectiveness. And with technological advances, proving results has become that much easier.

    DTx gives pharmaceutical companies the ability to collect real-world evidence on how patients are improving their outcomes while connecting the dots, and thus highlights an even stronger product impact.

  • The value of DTx for hospitals: As reimbursement and revenue models for hospitals move towards pay for performance and value-based care, hospitals need to solve for chronic disease outcomes and re-hospitalisation, and thus balance profitability with growth. In addition, hospitals often struggle with the ability to monitor and influence patient outcomes after discharge. By offering a solution that is oriented towards improved patient outcomes, patient and hospital care objectives are aligned and patients are inclined to continue treatment at a hospital.

    DTx solutions can serve as a means to improve procedure success and consultation success by improving overall patient health. Not only can patients then be taken earlier into surgery but they can also be assured of a reduced risk of complications or relapse.

The future of DTx in India and globally

Globally, there has been a high adoption of DTx in the diabetes, respiratory, cardio-metabolic and mental health space. Therapeutic areas that do not have a comprehensive suite of proven drug therapies in standard of care guidelines, such as select CNS conditions, are seeing even faster adoption.

But in India, DTx is at a very nascent stage. With a high barrier to prove outcomes, only a few solutions exist in the market.

In India, four major NCDs – CVD, diabetes, respiratory conditions and cancer account for 62 per centr of all mortality, with about 56 per cent of these being premature. Delivery of holistic care regimens above and beyond medication can have a large-scale impact in improving these health statistics. DTx, with their ability to scale, can transform the way NCDs are managed and cause a shift in the care paradigm from a pill only journey to a more comprehensive one.

Digital therapeutics come with the promise of revolutionising the way we manage diseases, because they can help track behaviour and support patients through their treatment journeys while being accessible, affordable, scalable and yet personalised.

I believe that in this decade, we will see more and more Indian health stakeholders incorporate DTx into their core value propositions. Few players who adopt DTx faster will realise an incredible advantage towards their outcomes, brand and value. Most importantly, this decade will finally see the patient at the centre of healthcare, and DTx will play a pivotal role in making that happen.

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