doctor holding a respiratory machine

In the first post of this two-part series, we discussed how device trends are impacting the market for inhaled respiratory therapies. We mentioned that GlaxoSmithKline, most notably, has partnered with Propeller Health to create an inhaler that is paired with a smartphone app to collect usage data via an internet connection. The impact of the “internet of things” on healthcare markets is a hot topic these days, but how will these forces impact the respiratory space specifically?

The majority of inhaled medications covered by our company are approved for both asthma and COPD; for market leaders, the prescription volume is split almost equally between these two diseases, though they have dramatically different patient populations with varying behaviors. Asthma affects a wide range of age groups—including young patients with pediatric asthma—so the medications required for disease control can vary throughout a patient’s lifetime. COPD, in contrast, affects an older population—with diagnosis typically occurring at age 50 or older—and this progressive disease typically requires additional therapy over time. The difference in age for these patient populations could, therefore, translate into dramatically different uses for smart inhalers.

Younger populations tend to be more inclined than older populations to integrate wearable technologies that are typically linked to smartphone apps, such as the Fitbit, into their lives. Thus, it is likely that the chance to measure and take control of one’s health could drive uptake of an integrated smart inhaler system among younger patients. The COPD population, in contrast, is more likely to be living on a fixed income and may not have access to the latest technology; this has the potential to keep COPD patients on older devices or cause them to shift to generics, both of which could restrict smart inhaler uptake for this indication. Though, it is important to note that, even among those 55 and up, one in five agree that wearable technologies linked to smartphone apps “have enormous potential in helping [them] manage [their] health”. Thus, there is potential for smart inhaler uptake in the COPD population as well.

The cost and reimbursement factors surrounding a potential smart inhaler are important to consider. Insurance coverage and financial incentives are among the top factors informing consumers’ decisions on whether to use emerging health technologies such as wearables and sensors. First, would a smart inhaler actually be more expensive? As none are yet available, we can only assume that the development and manufacturing costs would lead to a price premium. Second, if the cost is greater, would insurance companies be willing to reimburse for the more expensive therapies? It is likely that the larger companies, such as GlaxoSmithKline and AstraZeneca, will negotiate a rebate or discount with some insurers, but there are additional factors that could impact coverage, which leads to the third important factor: who would own and control the data generated by a smart inhaler?

One potential important use of smart devices is for the measurement of compliance during clinical trials, and this use is relatively unobjectionable. However, if a patient is prescribed a device, who would capture and own the data? Fitbit’s privacy policy, for example, indicates that the company does collect user data, but places a strong emphasis on ensuring privacy of personal information and safety in the storage of any data collected. Furthermore, the company is transparent about how it uses your information, with some of the focal points being improving user experience, developing content for marketing endeavors, and ensuring maximal accuracy in your personalized stats. In the case of the smart inhaler, however, what happens if insurance companies are permitted to collect and use the patient data captured by this device? They could measure compliance with treatment regimens much more accurately than is possible using patient diaries or self-reports. While this could improve treatment, it also could have significant drawbacks for patients. For example, step-therapy requirements are already in place for many inhaled therapies, but with smart inhaler data, a certain compliance threshold could be enforced before a patient is reimbursed for a later-line treatment. Additionally, these data could be collected as part of a cost-benefit analysis; for example, if patients are more compliant, costs of exacerbations that commonly require hospitalization could be decreased, thereby benefitting the entire healthcare system.

Smart inhaler technology is likely several years away from reaching the market, but the issues around this technology are complex and competitors will need to make a number of critical decisions around these types of investments. Nevertheless, there is strong evidence to support the power of an opportunity to help patients better adhere to their medication regime, with a Manhattan Research/DRG Digital Insights study finding that 61% of U.S. prescription drug users are interested in digital tools and services for medication adherence. GlaxoSmithKline’s agreement with Propeller Health shows a commitment to the potential of smart devices in the inhaled respiratory therapy space, and many of their competitors have already undertaken development of such devices. Although the outcomes of this market development are cloudy at this time, it will be an interesting story to follow over the coming years.

Follow Emily Hisey-Bowden, Keeley Cheung, and Matthew Arnold on Twitter for more insights on the intersection of digital and healthcare.

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