The role of new technologies in enhancing compliance

Peter Mansell reports on how compliance and personal monitoring technologies can help pharma firms better tailor their offerings to different patient groups



Peter Mansell reports on how compliance and personal monitoring technologies can help pharma firms better tailor their offerings to different patient groups



New technology is the lifeblood of drug development.


But there is also a parallel stream of technological innovation that addresses how drugs are taken, managed, and monitored in the marketplace.


These technologies range from enhanced packaging and reminder messaging (MedivoxRx Technologies Talking Prescription Bottle) to texts and e-mails to monitoring systems (Johnson & Johnson/Apples Lifescan application for glucometer data) to smart pills (from Proteus/Novartis) that keep tabs on a patients response to therapy within the patients own body.


These technologies are now being applied to address the long-standing compliance problem.


Only around one-third of medicines are taken as intended, and this issue has taken on new urgency in light of cost pressures on healthcare systems and trends such as ageing, multiple drug regimens, and chronic disease management.


 


Technological shifts


The more sophisticated these technologies become, the more they have the potential to overlap withand, indeed, shapeassociated trends in healthcare.


These include the shift from compliance to concordance in doctor-patient relationships; patient empowerment and the associated personalization of therapy; and a growing emphasis in health systems on value and outcomes.


The technologies also speak to a pharma business model that is shifting, somewhat fitfully, from a product- to a service- and data-oriented approach, while trying to maintain revenue streams in the face of payer constraints, patent erosion, and R&D productivity issues.


 


Is compliance cost-effective?


There is also, suggests Bob Damms, healthcare and technology expert with PA Consulting Group, a more fundamental question to ask: Is better drug compliance always cost-effective?


Compliance may eliminate waste, improve outcomes, and mitigate the risk of adverse events, but it can also push up costs significantly by bringing into the treatment fold patients who otherwise may not even have bothered to fill their prescriptions. 


Another part of this equation is making sure the drugs, once taken, actually work.


That is the goal of the more targeted, stratified therapies dominating the R&D landscape in categories such as oncology.


 


Value measurement and reimbursement policy


Technological developments also suggest, though, how drug compliance or concordance technologies could have broader applications in monitoring therapy effects as a function of value measurement and reimbursement policy.


In a recent PA Consulting article, Damms, Ian Rhodes and Gregory Berman suggest that, in the future, drugs, devices, diagnostics, and data communication will coalesce and be integrated to enable reimbursement to be based on outcomes in individual patients.


In this setting, it is the data used to manage medication, monitor patient compliance, modify treatments in response to real-time diagnostics, and/or trigger reimbursement that is of prime value, and other components are reduced to commodities, they add.


This model could favor companies operating at the volume end of the market.


 


The generics-plus-compliance model


As George Mac Ginnis, a connected health expert with PA Consulting, points out, brand manufacturers are not only running out of new compounds.


They face generics in those very long-term condition categories (cholesterol management, diabetes, mental health) where compliance/concordance will take on increasing relevance.


As the opportunities for stratified therapy emerge at a rather slower pace than the erosion of traditional revenue streams, brand-name companies may struggle to match a value proposition achievable through packaging of low-cost generics and an effective wrap-around compliance program, Damms warns.


The long-term benefits of these combinations may look a good deal more attractive to cost-constrained health systems than a state-of-the-art therapy with nominally better outcomes at a much higher cost, particularly with the increasing regulatory emphasis on head-to-head clinical trials that will throw these comparisons into relief.


 


Pharmerging markets


What also gives an edge to the generics-plus-compliance model is the growing attention to emerging markets as new sources of drug revenue.


As PA healthcare and technology expert Ian Rhodes observes, these markets not only need low-cost drugs but also tend to be free of the confused historical baggage of payment systems and regulatory processes that may cramp service innovations in the developed world.


He cites device manufacturer Medtronics roll out of product/service combinations for its heart pacemakers in China.


These were packaged with a remote monitoring/adjustment system that has fed back into Western markets. 


As to whether long-term health outcomes are compelling enough to justify the immediate additional costs of better compliance, measuring real impact may be a stumbling block.


For example, health and social care tend to be budgeted separately.


While there may be a clear overlap between these budgets and, by extension, clearer evidence of crosscutting outcomes in a category such as schizophrenia, that kind of direct correlation is usually hard to come by.


 


A role for compliance technologies


Nonetheless, Mac Ginnis sees a role for compliance technologies in areas such as tuberculosis, where the prevalence of drug-resistant strains is likely to be among people on the fringes of society.


In this case, building compliance into a broader package of care provides public health benefits in managing a hard-to-control disease, he explains.


And in the more mainstream setting, there could be opportunities for home chemotherapy with compliance and monitoring support that would eliminate the need for regular and onerous hospital visits to receive treatment.


I can see a whole series of ways of using compliance technologies and personal monitoring technologies to actually better tailor offerings to different groups, Mac Ginnis comments.


If these technologies then migrate into a payment-by-results system, that carries both risks for pharmaceutical providers (i.e., they dont get paid) and the kudos of offering new products on a no cure, no fee basis.


 


Managing wellness


As Mac Ginnis notes, even if a pharmaceutical company does not embrace this kind of arrangement for its own therapy, hospitals and other customers are coming under increasing pressure to justify the outcomes of their procedures.


That will open up a market for concordance or monitoring technologies that demand more than just GP visits.


In this context, Damms believes, there may also be a realignment of functions that positions pharmaceutical companies as just one part of a broader healthcare management conglomeration.


I can see a future world where wellness is managed by a data company be it an Intel or a Microsoft and episodic treatments [e.g., premium-priced oncology drugs] will be controlled by the pharma companies, he suggests.


And it may be in the nature of stratified therapies and their development process that these companies are much, much smaller than they are at present. 


Nowadays, Damms explains, you take your car to Kwik-Fit for all the regular maintenance a new exhaust, an oil change, new tires and you take it to the main dealer when your head gasket goes.


And that could be where the pharmaceutical company of the future steps in.


 


For more on technology and compliance, see The Internet as a compliance and health management tool.


For more on pharmerging markets, see Reassessing Russia's pharma market, Breaking into the Brazilian pharma market, Cracking the Chinese pharma market, and How to get ahead in 'pharmerging' markets.