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June 14, 2021

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The Sidebar looks at how one big pharma company is trying to unlock the potential of digital therapeutics (DTx), as the world deals with an ageing population and the realization that many health problems are best addressed by lifestyle changes complementing medical interventions.

There’s a famous study by the American Journal of Preventive Medicine that breaks down determinants of health – and the conclusion was that around 30-50% of someone’s health is determined by lifestyle factors.

About 20% at the very most is determined by medical care, and the remainder is decided by environmental, social, genetic, and psychological factors.

It’s thought that more than 80% of healthcare costs are spent on diseases that could be modified or even reversed through behavior change. This equates to around 20% of the whole US economy.

There are huge and untapped health gains to be had by addressing health issues caused by behavior and lifestyle, and in the coming years big pharma hopes to do this using novel approaches such as digital therapy and partnerships with tech companies.

Sanofi is one of the companies that is attempting to do this, and in an interview with McKinsey the firm’s head of digital therapeutics (DTx) Bozidar Jovicevic says that pharma aims to address this unmet need using technology to help change behaviors.

The French pharma company is already starting to work with a DTx partner in the field of depression, but like many firms it acknowledges there is much more to come from working in this field.

The company’s experience so far in DTx could be applied to other fields such as neurology.

In the interview, Jovicevic makes clear that DTx are not there to replace drugs – a standpoint that makes sense given the findings of the journal’s study.

Turning to digital technology is an obvious solution to the shortage of doctors and nurses, as the computing power of mobile phones allows patients to get access to technology, education and information.

Big pharma should not be afraid of the power of digital technology and should embrace it, according to Jovicevic.

He envisages two scenarios, with DTx used independently of drugs as part of a treatment program targeting diet, exercise or lifestyle.

In the second scenario a digital therapeutic is combined with a drug to improve its effect – this creates a “whole slew of opportunities,” Jovicevic said.

This can differentiate new products and allow them to be either bundled together or offered separately.

The message from Jovicevic tallies with the goals of SidekickHealth – the company addresses issues around behavior to produce improvements in treatment adherence and patient outcomes.

Using Sidekick’s approach, which is optimized for the pharma industry, also helps with access to real world data with further benefits in brand differentiation.

Overall DTx can add value to the existing medications and help to maximize the potential of those that are in the pipeline stage.

Pharma could play a big role in development of DTx, by developing them in partnership with startup companies that have the technological knowledge to make projects possible, according to Jovicevic

The different cultures found in pharma and DTx firms can be merged and “scaled up” and create new solutions that work, said Jovicevic.

But he identifies reimbursement as the biggest issue facing DTx. In the key US market getting private and federal insurers to reimburse these products has proved a tough ask, requiring creative thinking, new data, and new ways of analyzing it.

There are other challenges too, such as the right approach to marketing the product.

The conventional method using sales reps may not be a good fit, Jovicevic mused.

However, these traditional ways of marketing drugs to doctors are falling by the wayside anyway – he estimates that half of doctors do not see reps and the average sales visit lasts a couple of minutes at the most.

On the positive side the price of a standalone DTx product is likely to be lower than the cost of a drug, making them an attractive proposition if the clinical data supporting them are convincing.

The COVID-19 pandemic has seen an uptake in digital health products in general, and Jovicevic is optimistic that DTx firms will benefit in the longer term and be used regularly, as mobile devices become ever more accessible and popular.

His interview with McKinsey also demonstrates the ambition that big pharma is beginning to show for DTx products, and their potential to change treatment paradigms as companies attempt to tackle diseases before they develop.

“Twenty years from now, I’d like to be able to look back and say, ‘We were on the right track. We were trying to pioneer something that’s good for the world’,” said Jovicevic.

“And ten years from now, I’d love to see prescribing and using digital therapeutics become just standards of care—a normal thing, like prescribing a drug. That would reshape the practice of medicine,” he concluded.

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