When was the last time that you completed a full course of medication prescribed by your GP, taking each pill as prescribed, on time, every time? The truth is very few of us comply, which creates all kinds of problems both small, when it takes longer for us to recover, and big, when we help drug-resistant super bugs to take hold even more.
It seems that South Africans know a thing or two about treatment adherence. This is not surprising, given the long, hard battle being fought in South Africa to bring challenges such as Tuberculosis and HIV, and their nefarious combination, under control, without creating escalating problems associated with poor treatment adherence, particularly drug resistance.
Over the last decade South Africans have made valuable contributions to real-time support for treatment adherence. Dr David Green, as inventor and innovator of Simpill, and Ricci and Lloyd Marshall, a husband and wife team, as entrepreneurs and owners at Wisepill Technologies are good examples. Both use a portable medication dispenser with a GSM communicator, connected to Internet software that drives adherence services customized to patients’ unique medication regimens.
Simpill was a pioneering concept, invented in the early 2000’s by Dr David Green to help TB patients remain compliant. It’s now used in a number of countries to help patients manage their chronic conditions and avoid costly and unpleasant hospital admissions needed to deal with poor treatment adherence.
Wisepill was founded in 2007, contributing a suite of solutions to the real time adherence support. Wisepill’s been selected by Family Health International (FHI360) for their trials of antiretroviral agent Truvada and used by Massachusetts General Hospital (MGH), Harvard and Columbia Universities in HIV research in Uganda and in South Africa.
In 2011, Wisepill won South Africa’s Department of Trade and Industry (DTI) Technology Award in the category of small businesses. Director and owner Ricci Marshall said, “Our focus has been on providing innovative products and service excellence in the field of medication adherence. It is gratifying to see our solutions being used more and more for personal adherence management as well as in clinical trials internationally.”
So why don’t we see more of these technology solutions helping people stay healthy and avoid running up unnecessary costs? There are probably a number of reasons, though cost, often regarded as the key deterrent to serious scale-up, should not be one of them.
When I first came across these devices I was curious about the cost question, so produced a cost minimisation assessment of a SIMpill pilot, with Prof Maurice Mars of University of KwaZulu-Natal. Our assessment published in January 2012 found that the discounted net present value, the estimated value for money quantified by the accumulated economic benefits less costs over a project cycle, was nearly half a million US dollars. It also showed substantial improvements in health outcomes.
So either “if it sounds too good to be true it is” or something else is the limiting factor to their increased use, not costs. The real difficulty is that pilots do not deal with a wide range of additional, complicated issues necessary for wider implementation. Important factors such as integrating the new solution into regular working arrangements and dealing with affordability and the extra cash needed to finance the project.
Economic assessments usually don’t address these issues, though they do help to point in the right direction, so that more substantial cost benefit analyses, or eHealth impact assessments can be applied to tease out the hard work that’s needed to realise real benefits.
Without a doubt, real-time treatment adherence support is here to stay, and sound economic assessment methods will be critical tools to help position them properly. On both of these topics, South Africans are likely to continue to contribute, helping eHealth improve health and healthcare in Africa and elsewhere.