Prescribing Healthy Behaviour – Medica 2017

16th November 2017

“Unfortunately due to personal reasons I couldn’t attend the show and give the talk but still wanted to share my notes” – Yuval.

Overview

In the last few years much has been talked about the health effects of aging population and unhealthy lifestyle.

Over a billion¹ prescriptions are dispensed each year in the UK alone, with the majority of these being for lifestyle-related health issues such as cardiovascular illness and diabetes. These are valued by the NHS at over £7billion² for primary care alone, paid to large pharma companies such as Pfizer, Novartis and Roche.

Most of today’s chronic conditions can be prevented or at least better managed by affecting patients’ lifestyle, such as a balanced diet and physical exercise.

If there was a healthy lifestyle ‘drug’ which could be prescribed by doctors, consumed by patients and reimbursed / funded by healthcare payers such as governments / insurers it would probably be the most prescribed drug in the world.

So – let’s look at how we can make it happen! What is needed?

1.Define the ‘drug’

Although there is no ‘one size fits all’ in lifestyle, and especially in healthy diets, we can probably agree on some basic guidelines for sub-populations and then look at personalising it further. In fact, recent studies show that there is no big difference between types of diets in their weight-loss effect long term. Similarly, regular physical activity has been linked to sustainable weight-loss by increasing muscle mass and body metabolism.

2. Test the ‘drug’ clinically for benefits and side effects

Is this really needed? There have been hundreds of clinical studies (example) that showed the link between healthy lifestyle and physiological risk factors for chronic illnesses.

3. Package the ‘drug’

This used to be an issue for some time. However, with the availability of smartphones and the easiness of delivering content through mobile apps we can now overcome this challenge cheaply. In fact, the proliferation of mobile apps means that a high level of user engagement is a key pre-requisite to driving lasting behaviour changes.

4. Prescribe the ‘drug’ (and convince patients to take it)

In 2016 there was a study by University of Oxford where GP’s had an unprompted conversation with patients who were overweight / obese and referred them to a lifestyle focused weight-loss programme. The results were very positive – not only that most referred patients went ahead with the programme and consequently lost weight, but also the feedback from patients was that they perceived the intervention as positive and helpful.

5. Pay for the ‘drug’

This is where it gets a bit tricky. First of all – how much does it cost? Well, digital apps tend to have large development costs (one-off) and low marginal costs. So the more patients are using it, the less it costs per patient. I would argue though that you need to think about additional costs to employ specialists in clinics, such as dieticians and physical activity trainers to make these prescriptions most effective. You also need to consider the cost of time for doctors to discuss the intervention with the patients although I believe most of this time can be spent with (cheaper) the specialists mentioned and digitally on the app. One thing for sure – overall, preventing chronic illnesses is much cheaper than treating them. So any investment in these types of intervention is a sound financial decision and not just the right medical approach.

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“I hope that in the near future we will see these types of programmes being used by doctors across the world, benefitting patients, doctors and public budgets all at the same time” says Amit Ben-Haim, CEO of Cloudtag Inc.

Cloudtag’s solution

At Cloudtag, we developed such a digital programme and we are in the process of clinically testing it with patients for clinical efficacy. Early results from our single arm clinical trial with the University of Aberdeen show behaviour changes in users’ lifestyle – which will help with the sustainability of their weight-loss. Not only that, we have added two elements to make the programme more holistic and useful to doctors:

a. We integrated wearable sensors into the programme. This way the patient is monitoring their health & lifestyle and can easily see progress (weight, rest HR, steps, energy expenditure)

b. We built a back-end portal where doctors / other professionals can monitor their patients and use that to personalise their treatment and optimise the cost of it.

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1. Source: https://patient.info/medicine
2.Source: http://digital.nhs.uk/catalogue/PUB22302

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