Monitoring medication adherence for respiratory disease: bringing a proven innovation to market
- Late 1990s: Asthma patient Garth Sutherland starts developing a way to monitor use of inhalers and forms original company
- 2003: First clinical trials of inhaler monitors
- 2010s: Advances in Bluetooth technology led to interest and investment from pharmaceutical companies for patient trials
- 2020: Focus on digital and remote monitoring due to the pandemic led to increased real-world application
- 2021: Current product launched
- 2022: Joined the NHS Innovation Service and was connected with NICE, NHS Supply Chain and the Health Innovation Network (previously AHSN Network)
Helping people with asthma take medications correctly
In the late 1990s and early 2000s, Garth Sutherland, an asthma patient in New Zealand, developed a gadget that connected his asthma inhaler with his phone, to remind him to use it when he should. This was the first step towards Adherium’s Hailie® solution for asthma medication adherence.
Most people with asthma are prescribed two types of inhaler – a preventative inhaler to be used daily, and a rescue inhaler, for when a person is feeling short of breath. If the preventative medication is not taken regularly, the patient’s condition deteriorates, requiring increased use of the rescue inhaler. 70-80% of patients fail to take the preventative inhaler as required or don’t use it effectively, and in some cases end up in hospital.
Francis White, Adherium’s Vice President Of Global Business Development, explains, "Patients may not get the support they need to ensure that they’re taking their medicine correctly, and most hospitalisations can be traced back to the asthma not being treated effectively at home. People don’t always appreciate it can be life-threatening".
The current product has been built with public and patient involvement from the very start, and benefits from over 20 years of user feedback. They have influenced its ergonomic shape, how metrics from the sensors are displayed to patients, and the latest iteration for powder inhalers also has user-inspired design features.
The first company, Nexus6, was founded in 2001 and initial clinical trials were carried out in 2003. To date, over 13,000 people have taken part in clinical studies of the product.
"User feedback has influenced the ergonomic shape of the product, how metrics from the sensors are displayed to patients, and led to user-inspired design features"
A technological coming of age
Since the 2010s, the rapid development of Bluetooth connectivity has meant the system could finally reach its full potential. In its current format, the device is less than a year old, and now measures flow rate and time of use, reports these data to the user’s smartphone and links with their healthcare team.
"We know that it works", says Francis, "but one challenge is that the solution cuts across different pathways. We are linking with Integrated Care Systems to look at how it is commissioned, and with primary care and clinical teams to generate the demand".
Finding routes to market
A former NHS Innovation Accelerator fellow, Francis joined Adherium in April 2022 to bring the product to market in the UK. He contacted the NHS Innovation Service, and also reached out separately to Health Innovation Oxford & Thames Valley (previously Oxford AHSN), who have a severe asthma pathway, which includes e-monitoring.
The NHS Innovation Service has connected Francis with a number of agencies which have been able to help in different ways. Health Innovation East Midlands (previously East Midlands AHSN) has supported a bid for Small Business Research Initiative funding, and Imperial College Health Partners offered support. NICE also responded, putting Francis in touch with NHS Supply Chain, and separately Healthtech Wales is conducting an assessment of the product.
Francis says the 'one-stop shop approach’ is a big advantage.
"One area it’s easy to underestimate is the form-filling. Having a single application process through the Innovation Service to reach all these agencies has been really helpful"
The hidden costs of med tech development
Having a product that does what it says, and works well, is just the starting point, and more achievable when you involve patients and clinicians from the outset.
"People say medical technologies are too expensive, or that they can buy something similar online and it’s 10 per cent of the cost", explains Francis. "But the cost of med tech isn’t just the building, developing and testing, and clinical evaluation. You need health economic evidence to show the value for money, and a team of people to sell it because the NHS is a big institution. Don’t forget that commercialising your innovation, no matter how good it is, is probably the lion’s share of the work".
"I’d encourage any entrepreneurs to take a look at the NHS Innovation Service. The NHS realises that adoption and innovation in healthcare is hard, and they are working to support it".
- Patient-focused innovation that tackles human factors can have huge potential to save lives and money.
- Even if you have a proven product, good clinical evidence, and compelling case studies, you need to link with NHS funding and workforce priorities.
- The NHS Innovation Service can help reduce duplication and form-filling when seeking support.
- Engagement with local Integrated Care Systems is important, to understand who is willing to commission your innovation or can influence pathway change.