Saturday, May 31, 2008

Making sure you eat your Wheaties (and take your meds)

Patient compliance is a $30 billion dollar a year problem according to major pharmaceutical associations (DataMonitor). The challenge is universal, everyone is susceptible to procrastination regardless of GDP. Patient compliance has uneven consequences in different patient populations. We covered a couple of technologies aimed at developing world patients fighting TB. These are low-cost reporting and monitoring technologies that take advantage of widespread cellphone networks. One of the rationales for their use is to prevent the onset of a much more complicated disease. If they become too sick, their public health resources cannot support further treatment.

Closer to these shores, patient compliance takes on a different rationale. Insurers and healthcare sponsors seek savings through preventative medicine.

This has launched what I will term the pillbox technology: simple dispensers that report usage of a dispensing mechanism. Essentially, you get a reminder, a convenient dispensing mechanism, and the time and frequency of the dispensing is reported to a central location. The approach is not limited to pillboxes. It has also been expended to inhalers and glucose meters.

Pillboxes: Gaming the System

A major flaw in this approach is reliance on the Honor System. This is going to make me really unpopular in some circles: trusting on people to behave themselves all on their own is a risky strategy. Some patients require a high level of monitoring to ensure compliance since their life is on the line. Forget about taking your multivitamin everyday (I forget to)---if you don't take your full course of TB meds, you're not going to make it. And if you do, you're going develop multiple drug resistant TB. If you do, and your national healthcare system can't provide, you're not going to make it.

Enter the Adult Supervision Brigades...

The second method goes further and ensures that the medication has actually been taken. We'll call this Detect-and-Report. Detecting metabolized drugs in patients such as University of Florida spinoff Exhale’s breathalyzer technologies enhances compliance by ensuring that drugs have been taken. For some this may be a little too Big Brother, but in the end, one can argue that it’s for your own good. After all, a much higher level of compliance enforcement would be experienced that same patient is hospitalized.

Exhale’s technology is being used to ensure compliance in patients undergoing a HIV/AIDS trials. The noninvasive test relies on adding GRAS (Generally Recognized as Safe) biomarker tags that are detected on an electronic monitor---just like an alcohol breathalyzer. There is no word on pricing, but it could easily pay for itself if can enhance the confidence of a clinical trial.

On the other end of the spectrum of detection-and-monitor technologies is the XoutTB system which I have described earlier. At a cost of a penny a day, the system relies on metabolic testing integrated with a mobile reporting platform.

The recent development of detect-and-report technologies means that the jury is still out on whether the honor system works as well as active detection and reporting systems. We’ll stay tuned.

In the meantime eat your Wheaties, take your statins, and rafampin, and all those little bottles behind the mirror.

More on Exhale in their website.
Stay tuned for information on XoutTB or get in touch with us directly.

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