The digitization of health has been exploding over the last decade, from its early days of Quantified Self (QS), general wellness and health monitoring, to much more advanced technologies that can now provide evidence-based clinical interventions and disease treatments.
Are Digital Therapeutics Just Another Name for Digital Health?
The short answer is no. To understand distinct value and promise of digital therapeutics, it is important to understand the differences between Digital Health and Digital Therapeutics.
Digital Health applies to all technologies that engage patients around their health and wellness. The vast Digital Health landscape includes mobile health (mHealth), telehealth (a.k.a. telemedicine), devices, sensors and wearables, health information technology (HIT), personalized medicine and digital therapeutics.
So What Are “Digital Therapeutics” Exactly?
Digital Therapeutics (DTx) is a subset of Digital Health – a large and growing field encompassing a multitude of technologies, products and services across healthcare and wellness industries. The Digital Therapeutics Alliance (DTA), formed in 2017, is a global non-profit trade association of industry leaders and stakeholders engaged in the evidence-driven advancement of digital therapeutics. Thought leaders across the digital therapeutics industry, supported by the DTA, collaborated to develop the following comprehensive definition:
“Digital therapeutics (DTx) deliver evidence-based therapeutic interventions to patients that are driven by high quality software programs to prevent, manage, or treat a medical disorder or disease. They are used independently or in concert with medications, devices, or other therapies to optimize patient care and health outcomes.”
To expand on the definition, also supported by emerging market segments, there are two distinct categories of digital therapeutics. The first is comprised of therapies that extend the value of traditional pharmaceutical treatments. The second consists of therapies that potentially could replace traditional pharmaceuticals.
Replace or Supplement?
Digital therapeutics typically target conditions that are not addressed well currently by the traditional healthcare approaches, such as chronic diseases or neurological disorders. Another advantage of digital therapeutics is that they can often be more cost effective.
Over the past decade or so, digital therapeutics have progressed to supplement traditional clinical therapies and are poised to eventually replace some of them. An example of supplemental therapeutics are mobile apps and devices that help patients manage their medical condition(s) by conveniently reminding of medication time and dosage, and thus making medication adherence easier. While examples of alternative therapies include replacing medication to manage depression or insomnia with sensory stimuli delivered via a mobile device.
A recent report by Juniper Research found that the market for Digital Therapeutics will expand rapidly over the next 5 years, growing over 1,000% to reach more than $32 billion in revenues in 2024. The Digital Therapeutics & Wellness: Disruption, Innovation Opportunities & Forecasts 2019-2024 report states that the biggest applications for DTx will be diabetes and weight loss, generating more than $19 billion in 2024. This sector has already taken an early lead, as lifestyle changes proved to have a demonstrable impact on diabetes and weight loss. Additionally, the report expects high growth of Digital Therapeutics in other conditions, such as chronic obstructive pulmonary disorder, using computer games for developmental disorders and Virtual Reality (VR) for treatment of PTSD.
Barriers to Adoption
Despite DTx offering solutions to traditionally poorly addressed conditions and more evidence demonstrating their clinical value, Digital Therapeutics have not yet entered healthcare mainstream. What is preventing more physicians prescribing DTx, more patients using them and more pharmaceutical companies investing in them? A 2018 report by McKinsey & Company, Digital therapeutics: Preparing for takeoff, suggests that there are two main obstacles to wider adoption of Digital Therapeutics:
- Difficulty distinguishing Digital Therapeutics from the more general health and well-being offerings in the overall Digital Health market
- Misaligned incentives in the healthcare ecosystem
Resulting from investment of hundreds of millions of dollars, there are more than 315,000 health-related applications (IQVIA Institute report, November 2017). For consumers and even medical professionals, it is hard to separate unproven or low-value apps from those that have a proven therapeutic value. That’s why industry initiatives and organisations such as the Digital Therapeutics Alliance are important to provide the definition, the guidelines and frameworks.
Another barrier to overcome on the road to the wide adoption of Digital Therapeutics is the current misalignment of incentives between providers, payers, and pharmaceutical companies. Many digital therapies today require changes to healthcare provider workflows and increase physician burden by onslaught of data and required interpretation. From the payer perspective, offering reimbursement for digital therapy would make sense if better clinical outcomes can be assured within a time frame – an important consideration given the United States private health insurer market constraints. Consequently, health plans offered by employers or single-payer systems might be better Digital Therapeutics targets. Juniper Research predicts that “the majority of revenue will arise from direct payments from employers until 2021, and public health interest to be confined to a handful of markets.”
While the term Digital Therapeutic may still be unfamiliar to many, these therapies are here to stay. Digital Therapeutics (DTx) are becoming a new category of medicine, poised to address chronic and other hard to treat conditions. While much work remains for digital therapies to be integrated into and across the traditional healthcare ecosystem, Digital Therapeutics will “increasingly influence the way healthcare is delivered and consumed across the world”.