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COLUMNS
Reimagining Healthcare in Asia Through Digital Therapeutics
A rapidly ageing population, combined with a surge in chronic, non-communicable diseases is driving the rise of healthcare costs in Asia. Digital therapeutics holds immense potential to radically transform healthcare from reactive treatment to proactive, predictive prevention and management of disease.

Healthcare expenditure in APAC is projected to grow to 2.4 trillion by 2022, outpacing growth in the US and Europe. A rapidly ageing population, combined with a surge in chronic, non-communicable diseases is driving the rise of healthcare costs, rapidly outpacing the economic growth of some ASEAN nations and straining healthcare systems in others.

Four major non-communicable diseases - cardiovascular diseases, diabetes, chronic respiratory illness and cancer – contribute significantly to the growing burden in treatment costs in the region. While economic progress in Asia has led to lower poverty levels, there is a downside: social and lifestyle changes that include smoking, unbalanced diets, pollution, and a lack of physical activity, giving rise to chronic diseases that place an increasing toll on communities.

At least 60 per cent of people with diabetes live in Asia. Some of the world’s highest smoking rates can be found in the Asia Pacific region, with 2.3 million deaths a year from disease caused by tobacco smoking. 2 out of every 5 adults in Asia are overweight or obese: effectively the largest absolute number of overweight and obese people living in Asia. Australia faces heart diseases due to excessive caloric intake, while strokes are increasingly prevalent in East Asia due to excessive salt consumption.

Existing health systems in Asia are unprepared to meet the burgeoning demand and the economic burden of these illnesses. While traditional health systems have an overwhelming focus on treatment, there is a critical need to rethink the way we deliver healthcare across the continuum to drive increased improved patient outcomes.

Digital Therapeutics to the Rescue

Lifestyle and behaviour change are foundational for the prevention and management of patients with key chronic illnesses, yet are often difficult to implement due to limited resources, time and budget.

Digital therapeutics (DTx) offer significant promise to deliver better patient outcomes across the continuum of care in cost-effective ways. DTx refers to the use of technologies and digital interventions to better prevent, treat and manage diseases. Technologies like wearables, mobile apps, sensors, artificial intelligence and big data analytics are often used independently, or in conjunction with existing treatment to target conditions that are poorly addressed by the healthcare system today. More importantly, DTx enables and empowers patients and at-risk groups to take ownership of their health and healthcare decisions.

The global digital therapeutics market is expected to reach USD 13.8 billion by 2027, with the Asia Pacific witnessing the highest growth rates. The opportunity for digital therapeutics lies in three key areas: the use of DTx to predict, identify and prevent episodes of disease, the use of DTx to complement and augment drugs or treatment plans, and the use of DTx as standalone therapy to target unmet needs, or to replace existing drugs as a solution.

DTx as Prevention

One of the most powerful applications of digital therapeutics is in the identification, prediction and prevention of disease.

GlycoLeap is one such digital therapeutics provider that targets pre-diabetics, diabetics and those with at-risk conditions through personalised behavioural intervention using a convenient online personal health coach available around the clock. A pilot study shows that users improved their HbA1C diabetes control marker by 1.3 points and lost weight over a span of 6 months.

Mobio Interactive’s Am Mindfulness is a clinically validated therapeutic application that uses proprietary software and a smartphone camera to objectively measure stress, then deliver personalised resilience training that promotes neuroplasticity and prevents, measures and treats mental illness.

DTx as Complementary to Treatment

DTx can shape a more comprehensive strategy for pharmaceutical companies by augmenting traditional treatment through a drug+ offering. When combined with drugs, DTx can deliver interventions that bring a range of patient benefits, including better symptom management, efficacy, safety, adherence, improved quality of life, and better outcomes.

Neuroglee is a Singapore-based start-up that is focused on neurogenerative diseases. Its first product is aimed at patients in the early stages of dementia and complements medication and other treatments to provide cognitive exercises and tasks. The software tracks patients’ progress, such as the speed of their fingers and the time taken to complete exercises, to deliver personalised treatment programs. It also has features to alleviate depression and anxiety when used in tandem with other cognitive behavioural therapy techniques.

Proteus Digital Health is an innovative platform that drives drug adherence through an ingestible radio tag the size of a grain of sand. It can be placed inside a pill and send data to a wearable patch on the patient’s torso. For elderly patients managing multiple chronic conditions with an array of daily medication, Proteus’ sensors and the app can send alerts to notify patients, family members and primary care providers when a key dose has been missed. Trials have shown that Proteus’ system has shown a reduction in blood pressure amongst patients taking medication for hypertension.

Propeller Health has made a sensor that attaches to inhalers used by people who suffer from chronic asthma and COPD. The sensor monitors inhaler usage and provides feedback via a mobile app. Propeller has also partnered with GlaxoSmithKline to create a digital therapy platform that guides patients in using its asthma medications. Propeller Health’s asthma platform demonstrated a 79 per cent reduction in rescue inhaler use and a 57 per cent reduction in asthma-related emergency department visits and hospitalizations.

DTx as a Standalone Treatment

DTx can be employed to treat a condition independent of any other intervention or therapy and, at times, as a successful replacement of medication or treatment for conditions for which no drug currently exists.

Quitter’s Circle was a partnership with Pfizer and the American Lung Association to deliver a digital therapeutics solution to help people quit smoking. A user-friendly mobile app was developed by Appnovation that enabled smokers to join a ‘quit’ team with friends and family and provided access to resources, community, and support to help smokers face common obstacles associated with quitting while offering educational, social, and financial support.

Pear Therapeutics’ reSET is the world’s first drug replacement therapeutics and has proven to be twice as effective as traditional face-to-face therapy. reSET is a prescription digital therapeutic for substance use disorder. It is prescribed in place of a pill or injection to deliver clinically validated interventions via lessons that help modify their behaviour. reSET rewards patients for completing modules covering craving management life skills and other fields. It allows patients to self-report cravings and triggers to their physician, while their doctor or addictionologist tracks their progress via a dashboard.

Another example is Akili Interactive, which has developed a prescription digital therapeutic video game that helps children with ADHD. EndeavourRx is an FDA-approved video game that presents simultaneous sensory and motor stimuli that teaches children to manage competing cognitive tasks, shift attention between tasks, and ignore distractors.

While the digital therapeutics space remains nascent in Asia, it holds immense potential to radically transform the way health is managed. It can command the change from the current overwhelming focus on reactive treatment to a more proactive, patient-centric approach. As smart devices and sensors become ubiquitous and the acceptance of digital health technology amongst patients increase, DTx will emerge as a holistic and scalable solution that will help treat larger patient numbers at lower costs and support the delivery of personalised and real-time therapy to patients for improved outcomes. However, user experience, data, privacy, and regulatory frameworks will become critical differentiators of a digital therapeutics solution and need to be carefully considered in the context of the markets and health ecosystems of Asia to develop a deep, persistent and trusting relationship with patients.

References

  1. Asia Pacific Heart Network Retrieved https://aphn.info/prevention/tobacco-control/

  2. Economist Intelligence Unit (2018) Retrieved from https:// www.lek.com/sites/default/files/insights/pdf-attachments/ Expanding-into-Asia-Pacific-v2.pdf

  3. Fighting Obesity in Asia and the Pacific (2018). Retrieved https://development.asia/policy-brief/fighting-obesity-asia-and-pacific

  4. Merchant, et al. (May, 2016) J Allergy Clin Immunol Pract. 4(3):455-63. Retrieved from https://www.iqvia.com/ locations/asia-pacific/blogs/2020/07/the-rise-of-digital-therapeutics-dtx

  5. Merchant et al., (2018) WAOJ Impact of a Digital Health Intervention on Asthma Resource Utilization. Retrieved from https://www.iqvia.com/locations/asia-pacific/blogs/2020/07/ the-rise-of-digital-therapeutics-dtx

  6. Natanson, E. (July, 2017) Digital Therapeutics : the Future of Healthcare will be App based Retrieved https://www. forbes.com/sites/eladnatanson/2017/07/24/digital-therapeutics-the-future-of-health-care-will-be-app-based/?sh=681e8f397637

  7. World Economic Forum ASEAN. (2017) Retrieved from https://www.weforum.org/agenda/2017/05/non-communicable-diseases-kill-8-5-million-people-in-asia-each-year-we-need-a-plan-to-fight-them/

About the Author

Hema Thiagarajah is Vice President, Client Partner for Appnovation APAC. She has spent the past 15 years driving digital and customer strategies for organisations across the Asia Pacific region.

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