In 2021, the Pew Research Center estimated that 93% of US adults use the internet. Americans over 65 have increased their internet usage from 46% to 75% in the last decade. Globally, world internet usage is estimated at 63%, with highest engagement in Northern Europe, Western Europe, and North America—contrasting with lower implementation in Southern Asia, Western, Eastern, and Middle Africa (46%, 43%, 26%, and 25%, respectively). Smartphone usage has reached 85% in the US, and 78% globally. This worldwide acquisition of smartphones paves the way for better access to healthcare via credentialed apps.
Enhanced connectivity can play an important role in improving individual and public health—and making medical care more patient-centric. The European Public Health Association (EUPHA) predicts DTx can facilitate quality, accessibility, and equity in public health. They delineate benefits including:
- personalization and precision,
- data analytics,
- patient interaction and empowerment.
Moving from a Disease-Focus to Patient-Centric Care
Patient-centric care (PCC) has been defined as care that highly values patient preference, focuses on patient communication, and engages the patient in shared decision-making. Additionally, in PCC models, health promotion and prevention are valued and includes patients’ functional, spiritual, and occupational goals.
McKinsey & Company report that US consumers already prioritize patient-centric care and want to proactively manage their health, spending between 300 billion and 400 billion dollars of their discretionary income on health expenses. Additionally, Americans have increased spending by 40% on complementary wellness care, such as apps to support sleep, fitness, and appearance.
Beyond enhanced access, DTx places patients at the helm of their own healthcare. As an example, the Sidekick Health platform provides patients with the opportunity for daily monitoring of disease-specific progress and therapy response through adaptive care paths. With disease-specific education and programs designed to adapt to their needs, patients can enhance their health at home and between clinic visits.
So, rather than marginalizing patients as passive recipients of therapy, DTx empowers patients to be central to their disease management; and offers opportunities for new-world engagement with their doctors, clinician-researchers, and pharmaceutical companies.
Healthcare Stakeholders Embrace Patient-Centric DTx
Recognition of the benefits to public and individual health from digital therapeutics has informed the National Health Services of England (NHSE) pilot study for a digital diabetes prevention program (DDPP) as an alternative to face-to-face educational programs. The NHSE’s successful results mirror a US randomized controlled trial demonstrating significant diabetes prevention in participants. And a United States Centers for Disease Control and Preventions’ DDPP trial corroborated these benefits in a low-income population.
Beyond behavioral interventions, medtech companies—focused on developing medical device, diagnostics, and imaging technologies—are adopting digital health therapeutics ranging broadly from digital tumor board programs, like NAVIFY®, to integrating robotics and digital technologies to improve orthopedic joint reconstruction. 61% of surveyed medtech executives recognize adoption of digital technologies as critical to their company’s growth, prioritizing:
- data analytics (61%),
- artificial intelligence and machine learning (33%),
- cloud-based technology (33%).
Building Relationships Between Patients and Pharma
In the past, pharmaceutical companies met patients’ health challenges through the lens of disease-driven research. The scientific rigor required by the drug-development process inserted divides in pharma’s ability to communicate directly with patients. This hierarchy placed the patient—and their interaction with and response to pharma’s therapies—at the end-of-the-communication-line.
DTx provides a unique window into the patient’s world: symptoms, therapy, disease response, and quality of life (QoL). Pharmaceutical companies can leverage this patient-centric data garnered from DTx to provide better products and services.
In “Exploring digital therapeutics: The next paradigm of modern health-care industry” featured in Perspectives in Clinical Research, authors Drs. Raj Khirasaria, Vikramjit Singh, and Angelika Batta identify opportunities DTx offers the pharmaceutical industry for patient engagement. They delineate clinical benefits from digital therapeutics can be mined in three ways:
- Digital services – modifying patient behavior to drive a clinical outcome.
- Adjunctive digital therapeutics – indirectly improving clinical outcomes by complementing traditional therapeutics.
- Digital drug replacement – which requires clinical trials and rigorous approval processes.
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Can Something Digital be Personal?
Dr. Raj Khirasaria is a researcher and practicing physician in New Delhi, India, and is well-versed in the challenges of implementing digital therapeutics. Dr. Khirasaria observes a pharmaceutical industry already exploring ways DTx can interact with and benefit patients. The Sidebar asked Dr. Khirasaria if DTx can personalize patient care. He noted,
It’s very possible. For example, one company in India – making diabetic products – knows that there is a much greater need to control the glucose level and to personalize the insulin level. By providing an application and gathering this data, they can publish their results—helping patients, the community, and doctors as well. Many pharma companies have launched their digital therapeutics. They have pledged millions of dollars from their organizations. They have made sure that by 2030 that they will have separate arms for digital therapeutics.
Additionally, The Sidebar asked Dr. Raj Khirasaria: Can DTx help the pharma industry understand their patients better and are there equity issues for access to DTx? He commented,
I see patients in office hours—what I witness is that even socioeconomically challenged patients can use these apps. They use a smart phone. It is not a very costly product. Rather than spend hundreds of dollars or rupees on some costly medicine, the app can reduce the cost of their medicines…
Let’s say they want to measure their insulin trend in the last year. Even if the patients aren’t using that company’s product, the pharma company still offers that app to monitor the other products’ trends. It’s an indirect benefit the pharma companies are getting, and it’s just beginning. There is a lot more to be known. And a lot more to be offered.
Thus, DTx is uniquely poised to be pharma’s direct line of communication to the patient.
‘It’s not me, it’s you’
In a timely survey, Boston Consulting Group (BCG) queried patients and healthcare providers about what they wanted from pharma companies. BCG revealed patients and HCPs desired three main attributes:
- A commitment to affordable access.
- Clinical trials that “reflect real world and outcomes that matter to patients”.
- Pharma that “provides transparent information”.
However, BCG’s survey revealed that only 44% of patients felt that pharma companies met their needs. Patients expressed gaps in communication between themselves and pharma companies including seeking their input, maintaining sustained relationships, and involving them in product creation.
Several important revelations surfaced from BCG’s analysis. Patients, patient advocacy groups (PAGs), and physicians all valued pharma companies where patients were central to their mission. The most positively viewed pharma companies were those focused in a specific therapy area (TA) who sought significant engagement with patients across the healthcare system. Additionally, physicians were more likely to engage with, work with, and prescribe medication from patient-centric pharma companies.
In the past, many pharmaceutical companies remedied communication gaps by forming relationships with PAGs as their conduit to patients regarding their personal disease-related challenges. With the rise of DTx, pharma companies can now communicate with their patients at a granular level. Dr. Raj Khirasaria explained to The Sidebar:
The patient support societies are also leveraging these digital modes… In rare diseases, the number of patients might be so small: For example, Pompe’s disease has only 5000 patients receiving therapy. If a new product is coming, trials will be done. The pharma company should know: Where are these patients located? What are their preferences and modes of getting treatment? What are the difficulties they are facing? They should be learning from the patient support societies.
Inherently, DTx can fundamentally improve how pharma designs and conducts research—finding the patients they seek to serve and including them as ‘co-creators’ of pharmaceutical solutions.
DTx: Patients, Physicians, and Pharma Linked in Real-Time
Increasingly, our view for delivering healthcare and accessing state-of-the-art pharmaceutical science should be an interactive system centralized around patients and their individual needs. DTx can level the playing field for patients in this ‘ecosystem’ via:
- Increasing access to therapies and clinical trials—including underserved populations.
- Improving therapy adherence.
- Increasing patient comfort, privacy, and convenience.
- Optimized outcome monitoring.
Intuitively, as pharma and physicians meet patients’ goals, increased value in healthcare will follow. Value-based care (VBC) is defined as quality of care (usually assessed by clinical outcomes) tempered by cost. Healthcare economists recognize that VBC and PCC are currently distinct entities. Experts suggest that enhanced patient-reported outcomes (PROs) and integration of patient preference in clinical decisions and guidelines may help align these two goals, benefitting all healthcare stakeholders.
DTx’s direct relationship with patients facilitates PROs and identifies patient preferences—expediting the currently slow merger between VBC and PCC.
Drug and medical device development are revolutionizing therapy for life-altering diseases. Purpose-driven, DTx helps bring the ‘promise of science’ to the most important global stakeholder—our patient.
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About the author
Mary McGorray is a medical writer and board-certified internist who writes about medical innovation, healthcare economics, and public policy.
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