Dublin Global Gathering 2021

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At the end of October it felt like some normality had returned to Dublin as innovators and global leaders in the digital health space arrived to take part in our first in-person event in Ireland since the onset of the pandemic. 

We gathered in The Mansion House to discuss all things digital therapeutics (DTx), specifically, how to select the right DTx for a patient and also, how pharma and DTx developers should collaborate to create a DTx ecosystem for different therapeutic areas. 

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These thought-provoking conversations were facilitated at interactive roundtables, where leaders and innovators from a variety of backgrounds such as pharma, payers and entrepreneurs put their heads together to discuss these topics and to share ideas and opinions. A panel discussion then took place at the end of the day during which our roundtable anchors shared the key findings and insights from their tables.

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We began the morning with our first roundtable, discussing how we should select the right digital therapeutic for the right patient. There were many different thoughts, ideas and opinions voiced at these tables. Here are our top five takeaways from this session. 

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1. Increasing medical student’s exposure to, and incorporating training on, DTx: This could increase physician adoption and promote patient education and usability of these technologies.

2. We need to gain a better understanding on how patients engage with DTx: We should then adapt the solutions based on these findings, but it was noted that this approach is still in its infancy. It was stated that the best way to get this insight on patient adoption is to learn from a D2C model. This could lead to learnings from patient interaction and user experience to understand what incentivises patients to pay. It was advised that DTx who are applying to the DiGA should utilise the D2C market first, as this will help them to optimise their DTx for the customer experience before entering DIGA, after which, it is difficult to make amendments.

3. Increased focus on the customer experience: This is not the status quo in the traditional drug industry, this includes making the design more patient-centric, and considering how to encapsulate the entire patient in one user experience. This posed an intriguing question, does DTx need pharma if it has exceptional customer experience?

4. Barriers to administering the correct DTx to the correct patient: Evidence seems to be the dominant challenge in this space, it was suggested that the narrative needs to be changed to “some evidence is better than no evidence”. Another challenge was building DTx prescription into the clinician formulary, but how do we do this without enough available information? We also need to ask, do clinicians know how to use the data that is generated from a DTx? And do they feel confident in prescribing it with limited evidence? Lastly, it was stated that pharma has no incentive to invest early in the DTx space, which may be the reason why they are currently not drivers of these technologies.

5. Dosages: With traditional medication, this is typically a process of the patient trying many different options until the most suitable one is settled on. Even if a patient has multiple medications, despite the medications themselves differing, the experience is much the same as you’re taking a pill (or similar). However, this is much different for DTx, each “dose” or product is a completely different experience. There is endless variation in the user experience due to the DTx itself and the patient’s reaction to it, which again, highlights the need to consider the patient profile.

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Digital therapeutics need to be ready for the future, when these barriers we discussed are surmountable, and when the restricting legislation is lifted, the technology needs to be ready for the market and its patients.

Following our first roundtable discussion, a fireside chat was hosted by Eugene Burokhovich, Chairman and COO at YourCoach Health and Julie Murchinson, Partner at Transformation Capital, discussing how growth venture capital thinks about the DTx market 

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Later that afternoon we held a second roundtable session, during which we discussed how pharma and DTx developers should collaborate to create a DTx ecosystem and how this would look for different therapy areas. Here are our top five takeaways from this session.

1. How do we build this ecosystem? And who is involved?: Both pharma and DTx developers need to contribute, but they don’t need to be the only two at the table. The required players to build this ecosystem depends on the healthcare system, and shifting the focus towards interoperability creates the flexibility and incentive for this to happen. To realise this interoperability, we need to ask ourselves, who can drive back-end integration to allow for data exchange? Who owns the patient data? 

2. Who has the incentive to play in this ecosystem?: There seems to be a negative incentive for pharma to partake as the financial gain from the sale of traditional pharmaceuticals outweighs that of standalone DTx. It was stated that the internal pharma culture and attitude to DTx requires a severe shift here. It was also proposed that there may not be one ecosystem for one healthcare system, we need to give patients the choice of what best suits them.

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3. What does this ecosystem look like for comorbid patients?: In contrast to traditional medication regimes and polypharmacy, it isn’t feasible to have one patient on multiple DTx and the tolerance for how many DTx doses they would engage with in a day is presumed to be extremely low. The key to success here is to engage the patient in the right way. It was stated that this may be done by merging common desired changes across therapeutic areas into shared underlying solutions with varying interfaces based on the patient's unique situations. This predominantly stemmed from the observation that most DTx are geared toward inciting a behavioural change in the end user and so DTx geared at different conditions may share common end points.

4. Alternative routes to market: Many of these were proposed, such as other digital health companies being the route to market for DTx through a platform approach. Another suggestion was to consider DTx like the current trend of health coaches in the US and to bundle them into offerings geared at improving the overall wellbeing of the individual or catering to their unique physiology.

5. The DTx market requires some wins: We need to be able to show situations that have saved money and have improved outcomes. With the group of people we had present at our Global Gathering event, the feeling is that we are well on our way to seeing these market wins come to fruition.

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