The burden of chronic diseases is increasing globally. With the rising disease burden of non-communicable diseases (NCDs), the need for technology-enabled disease management solutions has further increased.
According to a report by McKinsey, in 2021, global digital health funding grew 79 per cent over the previous year to reach $57.2 billion. Over the years, digital therapeutics has taken a centre stage as it can include multiple factors like monitoring, medication adherence, behavioral engagement, personalized coaching, and real-time custom health recommendations.
Within digital health, funding for digital therapeutics (including solutions for mental health) has grown at an even faster pace—up 134 per cent from the prior year to reach $8.9 billion in 2021, the McKinsey report revealed.
In India, although Digital Therapeutics (DTx) is a relatively new field, it is growing at a significant pace. Companies like Lupin Digital Health (LDH) have already become a crucial player in the growing presence of DTx in the country. The company claims that it is a pioneer in Digital Therapeutics in Cardiology in India. Lupin Digital Health(LDH) is a fully owned subsidiary of Lupin, a transnational pharmaceutical company headquartered in Mumbai, India.
Financial Express.com recently got the opportunity to meet and interview Sidharth Srinivasan, CEO, Lupin Digital Health. During the conversation, Srinivasan highlighted the company’s role in cardiac care, upcoming business plans, role and importance of DTx in India, and challenges among others. He also informed that they have partnered with international connected device brands like iHealth, Lifescan, Wellue and Alivecor that integrate with the Lyfe app through Bluetooth. He also talked about their 6 Lead Handheld ECG and gave a demonstration of the point-of-care device. Excerpts:
What is the status of digital therapeutics in India? What more needs to be done?
Digital therapeutics is extremely nascent at the moment. The concept itself means that you can monitor patients remotely, you can diagnose them remotely, and then you can perhaps treat them. So, that’s the entire concept of digital therapeutics and in a sense, it has been long overdue…We have made a lot of progress in terms of technology on the hardware side…there has been a significant advancement in tools over time. But if you look at the consumer side of things…patient side of things or if you look at a doctor’s waiting room for instance…it has remained unchanged for the last 30-40 years.
In a country like India where for example we have all of 5,500 cardiologists for 1.4 billion people and India has the highest incidences of cardiac disease which means more than 30 crore people in India actually have some known risk of cardiac illness. You need a better way to amplify the reach and accessibility of each doctor. We have the world’s best specialists, they see a lot of caseloads, they are extremely good at their craft, they can do a lot in terms of productivity…we also have the best technologists. So, why not put these two together? At this point, we cannot recommend that this technology substitutes a doctor because technology hasn’t reached there but it can definitely point the doctor in the right direction by sort of minimising the options. We have seen globally in areas like mental health people actually want to be treated in the comfort of their homes. So, digital therapeutics has a lot of scope, and India as a nation during this year as part of our G20 presidency, we have actually taken digital health as one of the pillars.
Because for the global south, this is particularly important. Our physical infrastructure is not going to keep up with, at least in the short-run, with the disease burden. But we have so many advantages in terms of, more than anything else, people’s acceptance of technology is significantly higher in country’s like India than even the West…you have the willingness of companies’ like Lupin to invest in what is a nascent field, you have the willingness of doctors and patients to use technology as a way to get together, you have the emerging power of AI…what we have hit so far is not even the tip of the iceberg. But the kind of progress that you will see in the next 10 years is something that you have not seen in the last 50 years.
India has a low doctor-patient ratio as per WHO standards. Do you think digital health can help in overcoming these challenges and improve patient outcomes?
With digital health, the effectiveness of the doctor will increase as they will be able to cater to more patients. If you have a chronic condition, it means that you have to monitored continuously. There are extremely portable devices that you can use to do even an ECG. Our portable device can enable the user to take their own ECG and Blood pressure etc. Now the algorithm will give you a signal that you seem to be normal but the doctor can still take a call. When the doctor opens his app, he/she will be able to see your entire readings over a period of time. This is particularly important because people have a lot of variations in BP. This device can help the doctor in making informed decisions. This device is currently available in the market.
According to you, what are some of the key disease areas where digital therapeutics can be extremely helpful? What is the status of this trend in India?
Globally, diabetes is the most popular segment and I think for a couple of reasons. One, while it is a chronic illness, diabetes is a lifestyle disorder. It comes due to bad eating habits and theoretically, it can be reversed. Therefore, it is extremely popular as you can work directly with consumers. Globally, a company called Livongo was one of the first DTx companies, and following their path lot of companies entered this area. So, Diabetes is perhaps the most popular disease for DTx. Besides diabetes, a lot of global companies have worked on things like women’s health and mental health. Chronic illnesses, however, are where ultimately you will see the maximum of DTx simply because these diseases are life-long diseases. Let’s take heart disease for instance.
In India, in 2018, one-quarter of all heart attacks happen to people in 30s and 40s and that trend has only accelerated…so it’s not just improving the number of years and there is thumb rule that says as many as 8 years get added in cardiology through DTx. So, these 8 years and 30-40 years of better quality are what we are aspiring to achieve. In cardiology, in India, we are pioneer in this segment but I do expect that a lot of people will want to try this device, and the more the merrier. Honestly, this is a revolution.
What has been the role of Lupin Digital Health in this area? What are your upcoming plans?
So, Lupin Digital Health was started as we want to go deep into cardiology and try and make sure that we can assist cardiologists as much as possible through DTx. We don’t treat cardiology as one area, we break down cardiology into a number of indications…we have built clinical pathways or protocols to deal with each of these. So, the way you deal with a heart failure patient is very different from the way you deal with a post-ACS patient. We understand that these illnesses are very different from each other. We have followed all of the global guidelines and created pathways that can be delivered remotely. A lot of effort has been put in. It’s easy to build an entire protocol that requires face-to-face setup but then the number of patients I can help reduces and the cost decreases. We started with post-ACS…so we focused on people who had angioplasties and who need care afterward called cardiac rehab. We are now moving on to very soon heart failure which is one of the large underdiagnosed conditions in India. We will then move on to rhythm disorders and so on.
So, there is a continuum in cardiovascular which means that heart disease starts from someone just having hypertension all the way upto heart failure and there are a number of things in between and we want to cover all of this. We work with an advisory board of cardiologists to try and understand these conditions are tackled in India. We add to that global protocols and create something that will work in India and then gratify it by cardiologists. Once we deal with that care pathway, we do extensive testing with a limited number of resources so that we are able to get feedback, and improve these protocols, once we have readied the protocols then we launch them. We then need to have a feeling team that understands this and explains it to doctors and then demonstrates it to the patients.
One very important thing is that we do not deal with the patients directly as this is a prescription product. Our focus right now is completely on cardiology, having said that already 40 percent of the patients that we have taken onboard also have diabetes. So, somehow we are also dealing with diabetes. A significant proportion of users have renal diseases too. Some have mental health issues. So, in a very short period, we have to build our expertise all across these areas which means tomorrow we can look at entering these segments too. But right now the focus is strictly on cardiology.
As you are looking at covering from hypertension to heart failure, could you please share how you are planning to achieve your goal?
Every time we decide to tackle a new indication, we go through this well-versed process of creating an advisory board of doctors, inviting them to share their feedback…we also approach some practicing doctors too and then we try to bridge the gap…and then we create our protocol. So, that’s the first level of effort which takes around 2-6 months. The second effort is geographical expansion. We started with two cities and then we expanded to 5, then 10, and now currently we are in 15-20 cities and expect to be in 30 cities. From these 30 cities, we plan to cover 100 towns. Third part is definitely technology. We have to digitise a lot of protocols. We have to integrate a lot of devices. We have to make it easier for patients to do something which is otherwise meant to be done physically. For this, we have a DTx tech hub in Bangalore. These three things need to be done in parallel. So far, we have taken post-ACS live, we have taken high-risk CAD live, and we are taking heart failure live.
What are some of the challenges that India is facing with respect to patient outcomes and care? How can these challenges be turned into opportunities through DTx?
Medical sciences and Pharma have reached a point where outcomes are significantly better if the protocol is being followed. Unfortunately, what happens is doctors have a lot of loads and therefore they can spend only 10-15 minutes with the patient for medication and diet etc. But adherence is a challenge. So, customisation is important. Such customisations need to be cost-effective too for the patients. So, that’s the first part and the second part is of course, a lot of patients don’t follow up with their doctors. So, all of these, are something where we feel that adherence and awareness is a huge challenge in India along with monitoring.
Therefore, when we developed our programme monitoring, adherence and awareness were the key focus areas for us. If we fix this, the doctors will take care of the rest. And patients generally feel since I have done my AMC for myself for a few 100 bucks a month someone is there who is monitoring me 24×7. We provide a cardiac ambulance within 25 minutes if you press the SOS button on the app. So, we have that level of support. We nudge you for your medications. In our clinical trial, which we have published, we were actually able to show that 90 per cent of our patients adhere to their protocol against the usual average of 60-65 per cent. So, we are able to make that difference in people’s lives.
What are your upcoming business plans in the current financial year?
We intend to cover 70-80 per cent of all cardiologists in India. The first service that we can do is to make the cardiologists aware of the power of DTx. While many cardiologists are experts in the field and they have been to conferences globally and we learn a lot from them. But there are some cardiologists who are not much exposed to this global development and this gives us an opportunity to educate them about cardiac rehab and DTx and that’s the first focus. Can I expand the field? This is not just for us but for all the players who want to enter into this area.
A company like Lupin Digital Health, coming with the Lupin parentage…there is certain trust. Our focus area for us is to partner with hospitals. Ultimately, we understand that hospitals are places where all the interventions happen. If I am having a particular cardiac condition I will go to a nearby hospital chain, a well-known corporate chain known for its heart procedures. If I need to know more about DTx, I need to educate you when you are in the hospital and that’s the area we are looking at and we are sort of getting a lot of tractions. These are two large focus areas for us. In the next 3-5 years, we are hoping to touch a million lives as our MD, Nilesh Gupta says. So, that was the aspiration but this year the focus was how do we get the message out there to as many people as possible.