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HEALTH CARE AND PHARMACEUTICALS 2020: KEY FACTORS, EXPECTED TRENDS AND WAY AHEAD

Authors:
  • Dr Varsha's Health Solutions

Abstract

Health Care and Pharmaceuticals in India are two big segments which are fast growing and influenced by population, environmental, economic and technological factors. 2020 and the following decade will see innovation, expansion and increased effectiveness of these sectors. For Health Care: patient empowerment, strengthening peripheral health services and quality of care, an integrated therapeutic approach, along with leveraging big data analytics and technological advancements, will play vital roles in significantly enhancing and expanding health care in India. The collaboration of Pharmaceutical Industry with Health care and its practitioners will assume significant importance. Key factors like real world evidence and data, evidence based communication and rational promotion, Focus on drug safety and pharmacovigilance, scientific collaborations with key opinion leaders for updating and disseminating scientific knowledge to improve clinical decision making and patient outcomes, and all this coupled with an innovative pipeline will define the credible, long-term and prominent pharmaceutical players.
DOI : https://dx.doi.org/10.26808/rs.ph.i10v1.01
International Journal of Pharmaceutical Science and Health Care Issue 10, Vol.1 (Jan. Feb 2020)
Available online on http://www.rspublication.com/ijphc/index.html ISSN 2249 5738
©2020 RS Publication, rspublicationhouse@gmail.com Page 1
Health Care and Pharmaceuticals 2020: Key factors, expected
trends and way ahead
Dr Varsha Narayanan
Health and Pharmaceutical Consultant, Dr Varsha’s Health Solutions, Andheri west,
Mumbai.
Email: info@drvarsha.com web: www.drvarsha.com
ABSTRACT
Health Care and Pharmaceuticals in India are two big segments which are fast growing and
influenced by population, environmental, economic and technological factors. 2020 and the
following decade will see innovation, expansion and increased effectiveness of these sectors.
For Health Care: patient empowerment, strengthening peripheral health services and quality
of care, an integrated therapeutic approach, along with leveraging big data analytics and
technological advancements, will play vital roles in significantly enhancing and expanding
health care in India. The collaboration of Pharmaceutical Industry with Health care and its
practitioners will assume significant importance. Key factors like real world evidence and
data, evidence based communication and rational promotion, Focus on drug safety and
pharmacovigilance, scientific collaborations with key opinion leaders for updating and
disseminating scientific knowledge to improve clinical decision making and patient
outcomes, and all this coupled with an innovative pipeline will define the credible, long-term
and prominent pharmaceutical players.
KEY WORDS: Health Care, Pharmaceuticals, Real world evidence, Big data, AI,
Technology, innovation
INTRODUCTION
As we have entered the year 2020, it is apt to review the current size, and take a look at the
possible factors and trends which would influence and shape the healthcare and
pharmaceutical industry in the decade to come.
The global healthcare market which includes healthcare services and pharmaceutical drugs
(the former contributing 80%) reached a value of nearly $8.5 trillion in 2018, having grown
at a compound annual growth rate (CAGR) of 7.3% since 2014, and is expected to grow at a
CAGR of 8.9% to nearly $11.9 trillion by 2022.1 The healthcare services and pharmaceutical
drug markets are expected to grow at CAGRs of 9.3% and 6% respectively.
The fastest growing regions in the healthcare market will be the Asia Pacific and Africa,
where CAGRs of 13.4% and 13.1% respectively are expected to be seen.Healthcare in India
was a US$ 61.79 billion in 2017 and is expected to reach US$ 132.84 billion by 2023.2In
2020, the value of pharmaceutical products sold in the India is expected to reach $55 billion,
with double-digit growth in the coming decade.3
HEALTH CARE
Health care in India represents an eclectic range from the need for access to basic health care
and more peripheral health services, to having the most advanced facilities and technologies
DOI : https://dx.doi.org/10.26808/rs.ph.i10v1.01
International Journal of Pharmaceutical Science and Health Care Issue 10, Vol.1 (Jan. Feb 2020)
Available online on http://www.rspublication.com/ijphc/index.html ISSN 2249 5738
©2020 RS Publication, rspublicationhouse@gmail.com Page 2
at apex and tertiary care institutes. The 5 factors envisioned to play vital roles in shaping
health care in India, as well as in most developing economies worldwide would be: Patient
empowerment, Strengthening Peripheral Health Services and Quality of care, Integrated
therapeutic approach, using Big Data Analytics to improve Health care, and leveraging the
Technological boom.
Patient Empowerment
Patients today have much more access to health related information due to penetration of
internet.Asia has an internet penetration of 54.2% which represents 50% of the world’s
population.4India's internet users have registered double digit 18% growth to reach 627
million in 2019representing a 40 % overall internet penetration.5 87% of these are defined as
regular users, having accessed internet in last 30 days. Nearly 200 million active internet
users reside in rural India.5
The patient or consumer today is thus far more aware,due to all kinds of health information
available at the fingertip. However,‘empowerment comes from convenient access to
credible, and relevant health information. Therefore, sources of information would have to
come from credible sources like doctors with documented medical background, experience
and scientific acclaimed work, or from recognized medical associations, clinics or institutes.
These sources should also carry with them inbuilt online facility or remote-access for query-
interaction.The active role played by Health Care Providers (HCPs) in empowering patients
with right health information and guidance can be one of the keys to successful patient
outcomes and satisfaction.
Strengthening Peripheral Health Services and Quality of care
As well known the top of the pyramid cannot stand without a strong base. Peripheral health
care services and centers, which cater to the major vast population in developing countries
form the health care back bone which needs continuous strengthening. Presently there are
around 24,000 PHCs (Primary Health Centers) in India, each having one doctor (General
physician - health officer) along with nurse and health workers, catering to a population of
20,000 to 30,000.6Around 4 PHCs are mapped to the secondary level of care (First referral
units) called CHCs (Community Health Centers) which have pediatric and gynecological
specialists (and sometimes dentists) in addition to general physicians. The 5000 odd CHCs in
India are mapped to only around 600 district hospitals and further to 200 odd tertiary care
government hospitals.7
The health-care focus for the 2020 onward decade has to be on Family and Community
Medicine, whereinthe development and strengthening of the PHCs and CHCs could be
enhanced by participation from private specialty hospitals in towns and cities. There are
currently around 2500 such big advanced specialty/super-specialty hospitals in the country,
which can pioneer a wave of peripheral health care enhancement by taking up a CHC and its
mapped PHCs under their wing. This will not only improve facilities but also increase
cascading of knowledge, updating, training and educatingperipheral doctors, nurses and
health workers on basic patient care in various therapeutic and disease segments. This will
give a 3-fold advantage of improving quality of careand effectiveness, facilitate
accountability and monitoring, and giveperipheral doctors exposure to changing global
concepts in disease management and new drugs which will also encourage more medical
graduates to take up such peripheral positions.8
DOI : https://dx.doi.org/10.26808/rs.ph.i10v1.01
International Journal of Pharmaceutical Science and Health Care Issue 10, Vol.1 (Jan. Feb 2020)
Available online on http://www.rspublication.com/ijphc/index.html ISSN 2249 5738
©2020 RS Publication, rspublicationhouse@gmail.com Page 3
Integrated therapeutic approach
Health care has majorly focused on prescription and interventional medicine, with
streamlining and segregation of allopathic, and herbal/traditional medical practice. Today
there is great awareness and recognition of Dietary and Lifestyle factors in diseases. Several
herbs have now through clinical trials been approved for use in allopathic medicine as
supplements and drugs. Therefore, most diseases today require a holistic and integrated
therapeutic approach, which should complement drug therapy with lifestyle,
nutritional/dietary, psychosocial and scientific indigenous/alternative therapies, the last
having an important place in rural health care in developing nations like India.
The Indian healthcare system at the peripheral primary, community and district level is soon
going to see integrated allopathic and alternate medicine services in 50-100% centers by
2023.9Centers of Integrated medicine will also be set up in tertiary care teaching hospitals, a
process already initiated. For management of most chronic diseases, the trends in super-
specialty hospitals will also shift increasingly to team based integrated and holistic therapy
with lifestyle modification, diet structuring, natural supplements and psychological
consideration being important aspects of disease management for effective symptomatic
relief as well as long term benefit.10 Aims of therapy will trend towards Holistic Health and
patient Wellness, and this multidimensional approach will define game changers in managing
patients with Chronic diseases.
Big Data Analytics
The health care industry is the source of huge quantities of information that are now
consolidated and analyzed through the digitization of records. Stratification and consolidation
of this data and its analysis can help in understanding disease patterns, demographic and
epidemiological trends, patient risk factors and predispositions, seasonal and regional
variations, symptom patterns, comorbidities and associations, treatment trends and response,
disease prognosis, patient compliance and drug safety/adverse events.11
Big data analysis can thus improve disease prediction and prevention, timely symptom
recognition and diagnosis, as well as aid in predicting disease prognosis, and reducing
complications. In addition to its obvious benefit in patient disease management, big data
analysis can also help in better organization, improved efficiency and cost reduction for
hospitals and clinics of almost 25% reduction over a 5-year period. It also improves patient
engagement, convenience and monitoring, More and more health care providing centers are
moving to EHR (Electronic Health records) which are used to study the patient, disease and
response trends of the individual center as well as is pooled into the data lakes for larger
regional and national predictive analysis. Efficient barriers of patient anonymity and
confidentiality are vitally integrated, making big data analytics an ethical and pertinent
research tool for the advancement and effectiveness of health care in any country.12
Leveraging the Technological boom
Advancements and Innovations in Technology for Diagnosis and Treatment have always
been quickly embraced and adapted to by the health care industry. In diagnosis the
forthcoming decade will continue tofurther move towards non-invasive/minimally invasive
diagnostic techniques, decreasing duration of tests and its results (rapid/spot diagnostic tests),
increasing diagnostic precision, sensitivity and specificity through new technology or
upgraded versions, new tests for early diagnosis and screening, home/remote/in-clinic
DOI : https://dx.doi.org/10.26808/rs.ph.i10v1.01
International Journal of Pharmaceutical Science and Health Care Issue 10, Vol.1 (Jan. Feb 2020)
Available online on http://www.rspublication.com/ijphc/index.html ISSN 2249 5738
©2020 RS Publication, rspublicationhouse@gmail.com Page 4
diagnostic and screening modalities, and more diagnostic-interventional approaches in same
sitting to save patient time, and cost. Surgical advancements with improved tools, lasers, bio-
implants, and techniques will greatly improve patient outcomes and recovery time.
AI in health care
The most significant technological revamping of the health care system is predicted to be
through Artificial Intelligence (AI) and Remote/Telemedicine. The application of AI will be
seen in improving and revolutionizing mainly 3 areas of Health care: Diagnosis and
Treatment, Patient engagement and adherence, and administrative efficiency and
applications.13,14
AI mainly functions through machine learning, neural network and deep learningwhich can
help in designing treatment strategies and predicting outcomes based on various patient
factors, evaluate patient risk for any disease and increase diagnostic precision like recognition
of potentially cancerous lesions in radiology images, or the detection of clinically relevant
features in imaging data beyond human eye perception.
NLP (Natural Language Processing) includes applications such as speech recognition, text
analysis, translation and other language skills for the creation, understanding and
classification of clinical documentation, analyzing unstructured clinical notes on patients,
preparing reports, transcribing patient interactions and conducting conversations in the form
of patient support or assistant chat bots.Messaging alerts, relevant-targeted content and aiding
patient self-monitoring can initiate and modify human behavior and actions at important
junctures, positively affecting the overall treatment response. Patient data collected,
comparison and analysis from EHR systems, biosensors, watches, smartphones,
conversational interfaces and other instrumentation software can help customize
recommendations and follow-ups.
Robotics, which increases surgical precision, rises above the human limits of vision,
angulation and finesse, and reduces surgical, hospitalization and healing time, is poised to
take over the surgical space in a big way. Soon Robots with AI-based ‘brains’ will lead to
image recognition is being integrated with Robotic process automation (RPA).
It is important to note here that AI systems will not replace human clinicians but enhance the
patient care they can impart which can also help clinicians and HCPs to focus on and increase
time spent on aspects requiring uniquely human skills like empathy, persuasion, integrating
the big-picture and effective clinical decision making.
PHARMACEUTICAL ROLE IN HEALTH CARE
The role of the pharmaceutical industry is fast changing from being a producer and supplier
of medicines to being an active part of medical research, medical knowledge updating,
therapy shaping and enhancing patient care. Going ahead, the following will play critical
roles in enabling the pharmaceutical industry towork hand in hand with the health care
providers and medical practitioner in continuously improving patient treatment outcomes:
Real world evidence and data generation, Rational promotion and evidence based
communication, Drug safety monitoring and updating, Scientific collaborations with HCPs
and Innovative pipeline.
Real World Evidence and Data
All drug launches happen after randomized controlled trials (RCTs) have establish efficacy
and safety in an appropriately sized population. Real World Evidence (RWE) is derived from
the analysis of data collected from healthcare settings, outside the ambit of the strict patient
selection criteria of RCTs, and helps to understand observations and events in different kinds
DOI : https://dx.doi.org/10.26808/rs.ph.i10v1.01
International Journal of Pharmaceutical Science and Health Care Issue 10, Vol.1 (Jan. Feb 2020)
Available online on http://www.rspublication.com/ijphc/index.html ISSN 2249 5738
©2020 RS Publication, rspublicationhouse@gmail.com Page 5
of patients in routine clinical practice. RWE complements RCTs, which are carefully
controlled studies testing specific hypotheses (endpoints) on the efficacy and safety of new
drugs, and are not designed to represent responses in day to day or real world clinical
practice.15
The US FDA aims to publish draft guidance for the use of RWE by October 2021, In Asia,
(including India), there is growing awareness among regulatory authorities to structure the
inclusion of real world evidence into assessing long term efficacy and safety of approved
drugs in different patient groups and its benefit in clinical and economical decision making.
Though RWE generation is focused mainly on post launch assessment of drugs, soon earlier
stages of the clinical drug development pipeline may also start to use RWE to support critical
decisions. Now with companies specializing in generating RWE for the pharmaceutical
industry, the trend is increasingly going to shift towards RWE based promotion and
communication.16RWE will also be an important factor for several herbal and nutritional
supplements which have been launched for allopathic co-prescriptions in many chronic
diseases.
The HCPs and the pharmaceutical industry have a symbiotic relationship in RWE generation
with the former helping in effective data generation in clinical practice and the latter
designing its capture, regular and effective analysis and sharing of inferences through
scientific meets, publications and communication with HCPs. The HCPs use the inferences
for customizing treatment strategies and optimizing patient outcomes.15
Rational promotion and evidence based communication
This is an important aspect which can favorably impact the long term growth and credibility
of both the pharmaceutical industry and the HCPs as well as have bearings on drug
safety/adverse events, patient outcomes and pharmacoeconomics. There is a constant
interplay between company pressures and short term sales target, and indication, scientific
guidelines and clinical evidence based promotion, however regulators worldwide along with
World health organization are moving towards suggesting and slowly enforcing the same.17
The problem of irrational medicine use is particularly known to be worse in developing
countries with weak health systems, where mechanisms for routine monitoring of medicine
use are often not well developed or are at times non-existent.18 Certain category of medicines
like antibiotics, pain medications (NSAIDs, opioids), Drugs for anxiety/depression and sleep,
Corticosteroids, immunomodulators and cough/cold medications have been under scrutiny for
promotion in inappropriate indications, lack of adequate evidence/studies and increased usage
in milder-self resolving conditions or instead of other conservative/non pharmacological
remedies. Fixed dose combinations without clinical data of clear efficacy/safety over
monotherapy or available RWE of its benefit have also recently been discouraged by
regulators.
The future and long term key players in the pharmaceutical drug market will emerge from
those with rational promotion based on clinical trial evidence as well as RWE, the latter being
the game changer. Case based scenario approach in communication as well as regular drug
safety/pharmacovigilance updates will be seen as added values for prescription of the drug
and its recommendation in scientific standard clinical consensus and guidelines.Promoting
the rational use of medicines requires effective policies as well as efficient collaboration
between pharmaceutical companies, health professionals, regulators, patients, and entire
communities. 18
Drug safety monitoring- Pharmacovigilance
To improve the ability of patients to receive high-quality, safe, effective, and timely care,
better information via pharmacovigilance will be a priority in the decades to come for the
DOI : https://dx.doi.org/10.26808/rs.ph.i10v1.01
International Journal of Pharmaceutical Science and Health Care Issue 10, Vol.1 (Jan. Feb 2020)
Available online on http://www.rspublication.com/ijphc/index.html ISSN 2249 5738
©2020 RS Publication, rspublicationhouse@gmail.com Page 6
regulators, HCPs and patients. Digitization and electronic records and regular generation of
RWE as well as post marketing studies can harness drug safety data effectively along with
individual reporting by HCPs.
Developing validated tools and techniques for "predictive pharmacovigilance" will help
health systems in better understanding of the risks and benefits of drugs/medicines as to the
journey of a new medicine from risk-benefit regulatory efficacy to real-world risk-
effectiveness and tolerance.19 This will aid in comparing preapproval predictive
pharmacovigilance data, to better understand the potential gap between what was predicted
and what was actually measured in the real world scenario. The focus of pharmacovigilance
needs to shift from a regulatory compulsion and exercise to an essential part of scientific
communication, and building RWE.20
One of the need gaps is the disconnect between the field force and medical representatives
driving promotion, communication and prescription with HCPs, and the drug monitoring and
PV systems within the company. Integrating the two via Medical affairs and Medico-
marketing professionals can help bridge this gap, and change the perception of
pharmacovigilance being a hurdle to one of being a value add for scientific brand building.
Scientific Collaboration with Key Opinion Leaders (KOLs) and HCPs
The Health care world is a dynamic and constantly evolving space with newer and newer
data, drugs and treatment modalities coming in frequently. This leads to need for constant
knowledge updating; modifying, optimizing and customizing treatment strategies, guidelines
and recommendations; and cascading the same effectively down to the periphery. The role of
collaborations between Health Care centers, Apex institutes, Key opinion leaders and the
HCPs including those at peripheral level, cannot be emphasized enough.
More and more pharmaceutical resource allocation is being seen in conduction of such
scientific advisory meetings for discussing and analyzing changing and new therapies and
treatment concepts; preparation and cascading of consensus, teaching modules and treatment
recommendation/algorithms to HCPs across the country; supporting skill upgradation
workshops for both experience and freshly graduated HCPs; Enhancing academic sessions at
conferences through data and technological support; and last but not the least participate
actively in enhancing patient screening, diagnosis and outcomes.21 The last is especially
important as pharmaceutical support can be effectively harnessed for monitoring and
improving drug compliance and assisting physicians in increasing patient awareness.
Innovative pipeline
The future is moving from symptomatic to etiological management as well as preventive
medicine which has already heralded the era of biopharmaceuticals (Biologicals and
Biosimilars)for several tumors, and chronic inflammatory and degenerative diseases. Further,
other different types of innovative therapies likeCell and Gene therapy(CGT) products,
Immune-modulation agents, CAR-T (Chimeric Antigenic Receptor therapy) for cancers and
autoimmune diseases, harnessing therapeutic benefits of natural substances in food, soil,
herbs and animal sources,and using phage therapy to combat antibiotic resistance, are some
that are likely to see positive study results and therapeutic usage.22
Innovation in drug delivery and improving patient compliance is going to be a thrust area
with particle size reduction and improved absorptive properties like nanosphere technology,
alternate delivery routes for many injectable drugs like nasal/dermal/mouth
dissolving/conjunctival and inhalationaldelivery routes for many injectable drugs, targeted
drug delivery with sensors, matrix technology to extend duration of drug action, and other
NDDS (Novel drug delivery systems).
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There are also several pipeline new drugs in existing drug classes with multi-prong
mechanism of action and better pharmacokinetic profile and tolerance for improving patient
compliance, and treatment outcomes for many of the acute and chronic diseases. On the other
hand, more economic generic versions of innovator drugs will also continue to add to the
growth of Indian and Multinational pharmaceutical companies both domestically and through
export.
Conclusion
The focus in Health Care in developing economies is on Family and Community Health
which involves enhancement from the base to the apex with strengthening of peripheral
health centers. Symptomatic and segregated approach has now given way to holistic and
integrated therapeutic approach with emphasis on long term wellness. Patient empowerment,
and engagement are now important components of disease management while data analytics
and real world evidence will increasingly guide treatment strategy and clinical decisions.
The 2020 decade ushers in a period of growth, expansion and innovation in both the Health
Care and Pharmaceutical space, with more scientific collaboration for enhancing clinical
decision making, customized and holistic treatment strategies, patient engagement-adherence
and improved clinical patient outcomes.
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