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Here at the opening of the 23rd annual international
meeting of ISPOR in Baltimore - 10 years after we started attending
this event - the theme of digital health pervades the floor in
almost every session for the first time. The prominence of the
topic at a conference that historically has focused squarely on
pure drug and medical device development highlights the significant
emerging impact that digital health is having on the development of
new health interventions, as well as reinvention of old
technologies. There are persistent discussions on the seemingly
overwhelming obstacles to adoption of digital health - but the very
fact that they are being discussed, rather than dismissed or
ignored, reinforces the willingness to explore the revolutionary
role that this area can play in healthcare decision-making.
The problem for a group such as ISPOR, which puts validated
evidence, clinical outcomes and modelling techniques at the heart
of its very existence, is that this is precisely where digital
health falls very dramatically short. Nobody doubts the growing
influence of almost all areas of digital health - in 2016 a survey
pointed to 88% of respondents using at least one app to track or
manage their health. And the potential benefits are equally clear:
rapid, accurate detection and monitoring of health, increased
patient adherence, important medical knowledge sharing, digital
therapeutics, and many more. This fills an important gap for many
illnesses - it is interesting to note from the sessions that by the
largest proportion of health-related apps target diseases such as
mental health, depression and autism, which are conversely the
diseases where the global pharmaceutical industry has significantly
reduced its investments.
But there continues to be a dearth of evidence generation in
this area. Out of the hundreds of apps on the market, there are
less than a dozen with health outcomes studies, and only half of
those showed clinically meaningful results. This makes value
communication very difficult, and highlights fundamental
differences in the business models between digital health companies
and traditional pharmaceutical organizations. Indeed, while the
theme of the conference is digital health, it is unclear whether
critical elements of the digital health industry are even in the
audience.
Part of the problem is also the lack of clear understanding of
how regulators and payers approach this new industry segment.
Our own data suggests that payers only account for 4% of total
sales of consumer medical devices, compared to 77% from retail
bricks and mortar sales - and that this balance is not forecast to
shift any time soon. In fact, the only area that is growing
substantially is online sales, which now accounts for a fifth of
the market.
And there are more problems - notably access to technology and
internet in rural and poor areas, as well as significant privacy
and security concerns. But the conclusion remains that digital
health is infiltrating almost all areas of healthcare delivery, and
represents one of the most dramatic patient-empowering advances in
an era where real world evidence has increased prominence. Patient
associations are beginning to take notice, and some are beginning
to include the use of particular healthcare apps in their
guidelines, while some payers are showing interest in adapting
their approach to incorporate these technologies.
So, here at the home of Edgar Allan Poe in Baltimore, it seems
appropriate to conclude that we can nevermore underestimate the
role of digital health - it is here to stay, and represents an
important component in the development of any new healthcare
intervention.