ISPOR Asia Pacific Summit 2022 – Closing plenary
Kerryn Butler-Henderson, PhD, MPH, MBA, Director of RMIT Digital Health Hub, RMIT University, Melbourne, Australia
Raymond Francis R. Sarmiento, MD, Director of the National Telehealth Center, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
Guangjun Yu, MD, PhD, President of Shanghai Children's Hospital and Director of Medical Informatics Research Institute, Shanghai Jiaotong University, Shanghai, China
Kohta Satake, MD, MBA, MPH, Chief Executive Officer of CureApp; Tokyo, Japan
Innovations in digital health technologies have become increasingly available for patients, providers, and health systems. There is a raft of technologies that could be considered digital health technologies, for example: apps aimed directly at patients and consumers; apps aimed at patients with the interaction with their clinicians; systems aimed at clinicians for example, decision support systems, and digital tools that can be implemented at a system level, such as electronic medical records. These technologies offer significant promise for improving patient outcomes and reducing inequities; however, these potential benefits need to be balanced against potential downsides. This session considered how these innovative technologies can be considered within a health technology assessment framework, or other evaluation frameworks to measure how they improve patient health outcomes and equity.
This brief summarized a couple of reflections from the experts.
DIGITAL HEALTH INNOVATIONS IN THE PHILIPPINES
Raymond Francis R. Sarmiento, MD, Director of the National Telehealth Center, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
Innovation drivers in healthcare is cyclical in that the digitalization of health and healthcare lead to rapid evolution of science and medicine, which in turn, leads to an eventual rise in costs and thereafter, spurs on the digitalization of the healthcare sector. But it is important to note that digital health is more than just the technology – we are all doing this to improve the outcomes and access to services of the patient. Hence, in order to bring on sustainable and cost-effective digital health innovations, we should be attempting to answer the policy questions that are appropriate for our setting such as barriers to implementation, technical requirements, and how to efficiently leverage Big Data including social media data.
In the Philippines, based on lessons we have learned for the past 15 years with more lessons learned during the COVID-19 pandemic, we have applied those digital health lessons to make sure that we continuously improve access to healthcare services while keeping costs at a minimum by deploying electronic medical record systems, interoperability initiatives, blockchain technology, and national vaccine information systems – all in accordance to the national health program, national eHealth strategic framework and plan, national unified health research agenda, and the 2018 Universal Health Care law.
We hope that by continuing to make new and sustaining existing key investments made in infrastructure, human resource development, and research and development, we will be able to improve productivity, increase overall process efficiency, and disseminate quality knowledge products.
SMART HOSPITALS DEVELOPMENT IN CHINA
Guangjun Yu, MD, PhD, President of Shanghai Children's Hospital and Director of Medical Informatics Research Institute, Shanghai Jiaotong University, Shanghai, China
The construction of smart hospitals stems from the development of smart cities, which are the extensive application of artificial intelligence, internet of things, big data and other technologies in hospitals. In 2018, the National Health Commission of China put forward the goals and evaluation criteria for the construction of smart hospitals, including smart service, smart clinical and smart management, which has become an important part of the high-quality development of public hospitals proposed in 2021. Many hospitals in China are actively exploring smart hospitals. Shanghai Children's Hospital is one of the leading demonstration hospitals. Guided by demand and supported by technology, this hospital proposed a 5R model for the development of smart hospitals, including five aspects: patient relationship management (PRM), electronic medical record (EMR), scientific research information system (SRIS), hospital resource planning (HRP), and regional health information system (RHIS). This hospital was the first children hospital to establish an internet hospital in 2020. It is the first children's specialized hospital to pass the international HIMSS7 evaluation. It has established a scientific research big data platform covering 18.83 million medical records, and independently developed GPS, a clinical decision support system for rare diseases, and an artificial intelligence auxiliary diagnosis system for children's bone age. It effectively improves the diagnostic efficiency and quality of doctors. In addition, the hospital has realized effective monitoring and management of hospital energy consumption by using the Internet of things technology. In 2018, the Children's hospital began to use logistics robots to deliver medicine, which effectively reduced manpower and improved the safety of delivery. Telemedicine has been effectively applied in the medical consortium led by Children's Hospital, covering more than 90 medical institutions, and has played an important role in improving access to medical services in the context of COVID-19 prevention and control.
DIGITAL THERAPEUTICS (DTX) IN JAPAN
Kohta Satake, MD, MBA, MPH, Chief Executive Officer of CureApp; Tokyo, Japan
In Japan, the concept of Digital Therapeutics (DTx) has emerged as a novel therapeutic tool with the revision of the Pharmaceutical Affairs Law in 2014. In the revision, programs intended for diagnosis and treatment became recognized as Software as a Medical Device (SaMD). Management with DTx for nicotine dependence and hypertension were reimbursed by national health insurance in December 2020 and September 2022, respectively, and they are now in use in the practical medical situation.
All citizens are required to be covered by public medical insurance, and it is important to discuss the cost-effectiveness of the medical care provided by the insurance in Japan. According to the study examining the cost-effectiveness of DTx, the use of DTx for nicotine dependence, compared to treatment as usual (TAU), reduced lifetime medical costs by approximately $9,000 and increased quality and duration of life by approximately 1 QALY. Furthermore, for hypertension, the use of DTx showed an increase of 0.092 QALYs and increased lifetime medical costs by $962 compared to TAU. The incremental cost-effectiveness ratio (ICER) is a statistic used to summarize the cost-effectiveness of a health care intervention. The ICER of DTx for hypertension is $10,434/QALY and below the hypothetical threshold value in Japan of ¥5 million ($43,478) , which indicates that DTx for hypertension is cost-effective in Japan.
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