Clinical Research Organisation India
The appetite for digital health is increasing in the country. This is where developing metrics that capture the economic value of digital applications for patients could help health insurance payers negotiate prices effectively and thus drive further consumer adoption, said Sally Else, president, Mphasis Javelina.
In 2018, the global venture capital invested US$ 9.5 billion into digital health. The key investment areas included consumer health information, digital gym equipment and healthcare consumer engagement. However, these areas largely do not impact healthcare delivery despite these offerings being available to providers, members and payers. The US industry too historically lacked incentives for the roll out of digital care primarily because it is structured on a Fee-for-Service model and therefore provided little incentive for use of telehealth/telemedicine, she added.
Health insurance payer organizations are increasingly making digital practices available to their members often via partnerships with technology providers. For instance, the US-based health insurance company Aetna partnered with Apple to offer members ‘Attain by Aetna’ which offers rewards and the opportunity to monitor health activity via a wearable device, Else told Pharmabiz in an email.
Mphasis as an IT service provider in the cloud and cognitive space adopts artificial intelligence among others to assist its customers in knitting together available technologies. Ongoing consideration, of course, is driven by the need for security across the data landscape, within the back-office and at the member identification level, Else stated.
Sharing some cases of digital technology adoption in the healthcare sector, she said, “Simple examples include using an app to find a health insurance provider with an advantageous location, quality score, price for the treatment being sought, use of automated customer service agents like BOTS to respond to enquiries regarding benefit plan features, eligibility and potential medical fees or the status of a previously submitted claim are all available via smart phones. Another example is wearable devices that can sense movement like for instance a fall, weight loss or gain to support patients at homes rather than accessing an in-facility care.”
With the changing behaviour of members who expect a higher standard of service including access to information which allows them to customize their experience, the healthcare industry is now embracing a ‘consumer-centric’ value proposition. This is a phenomenon being observed globally and being answered with the adoption of digital point solutions be it pricing transparency tools to support their choice of care, wearable devices to monitor health and access portals that offer a centralized view of their healthcare experience or insurance claims status.
The challenge, however, is in enveloping these individual digital solutions into a single holistic and engaging view for the member while also allowing efficiencies along with a framework for lean healthcare operations. Together with the member, an optimal solution that supports the provider or payer business entity is also a must. This is where Mphasis helps healthcare insurance payers transform their businesses to modern back-office operations. Here our Front2Back framework provides allows access to relevant and timely data, she said.
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Many of you will be aware of how fatty build-ups in the arteries can increase the chances of developing heart problems, but now scientists have found early evidence the same sort of clogging could happen in the lungs – and it might be linked to asthma
It’s already known that people who are overweight have a higher risk of asthma. Before now it was thought the connection could be caused by extra pressure on the lungs, or additional inflammation in the body. Now there’s evidence fatty deposits may play a part, too.
Using material collected from an earlier study, the researchers looked at lung tissue samples from 52 deceased people: 15 with no reported asthma, 21 with reported asthma but who died of something else, and 16 who died of asthma itself.
With the help of dyes to highlight the airway structures, almost 1,400 samples were analysed.
What they found was surprising – accumulated fat (adipose cells) in the airway walls.
What’s more, the level of fatty tissue correlated with the body mass index (or BMI) of the individual – more weight meant more fat.
“We’ve found that excess fat accumulates in the airway walls where it takes up space and seems to increase inflammation within the lungs,” says physiologist Peter Noble, from the University of Western Australia.
“We think this is causing a thickening of the airways that limits the flow of air in and out of the lungs, and that could at least partly explain an increase in asthma symptoms.”
It’s the first time fatty deposits have been spotted in the lungs, although they do appear in other organs besides the heart, including the liver.
And while this doesn’t rule out previous hypotheses about how additional weight makes asthma more likely, it could be another factor to consider. It appears the fat actually alters the structure of the airways and increases inflammation, which is again linked to asthma.
The exact mechanism that’s causing the fat to appear in the airways isn’t clear at the moment – that’s something that’s going to have to wait for the next batch of research. It’s also going to be important to run tests on a greater number of people than the 52 involved here.
Another question is whether the effects might be reversed with weight loss – whether with regular exercise and a healthy diet, the fat levels inside the lungs would start to decrease as a person’s overall weight was lowered.
What’s certain is that we need a better understanding of obesity and its effects, as well as better ways to tackle it, and fast – by 2025 it’s estimated that 18 percent of men and 21 percent of women around the world will be classed as obese.
One recent study has compared obesity to an infectious disease, in the way that we might ‘catch’ unhealthy behaviours from those people around us.
What the latest study does is suggest another reason why maintaining a healthy weight is so important to the proper functioning of the human body – and the more we know about that, the better we can aim towards it.
“This is an important finding on the relationship between body weight and respiratory disease because it shows how being overweight or obese might be making symptoms worse for people with asthma,” says Thierry Troosters, president of the European Respiratory Society, who wasn’t involved in the study.
“This goes beyond the simple observation that patients with obesity need to breathe more with activity and exercise. The observation points at true airway changes that are associated with obesity.”
The research has been published in the European Respiratory Journal.
Pharmacy experts from the academia and the research centres in the country are now on an aggressive mode to devise strategies to tackle antimicrobial resistance (AMR). As a global concern, the impact is so profound that AMR is being tackled on war footing.
There is growing concern as new resistance mechanisms are emerging and spreading globally, threatening the ability to treat common infectious diseases, resulting in prolonged illness, disability and fatality. Hence it is the responsibility of pharmacists, doctors, dentists, paramedical practitioners, researchers, teachers and students to create a platform for exchange of ideas and to share the knowledge and approaches to take this challenge head on.
Taking the lead in this initiative is PES College of Pharmacy, Bengaluru has recently organised an International Conference to bring to the fore experts for highlighting this aspect which is crucial and affecting the entire world.
The conference was aimed at bringing into focus the problem as well as creating a platform for exchange of ideas and to share the knowledge and approaches to take this challenge head on. We had invited eminent scientists from India and other countries as resource persons. All our efforts were directed towards getting the involvement of eminent scientists, researchers & research scholars who are doing pioneering work in this field to exchange and share their experiences and research outcomes. Such eminent persons from different countries were invited to deliver lectures during the 2-day conference, stated the organisers.
AMR happens when microorganisms like bacteria, fungi, viruses and parasites mutate when they are exposed to antimicrobial drugs such as antibiotics, antifungals, antivirals and antimalarials. Microorganisms that develop antimicrobial resistance are referred to as superbugs. WHO too has been leading multiple initiatives for AMR to address antimicrobial resistance like World Antibiotic Awareness Week held in the month of November every year since 2015 with the theme ‘Antibiotics: Handle with care’.
We see AMR as a complex problem that affects all of society and is driven by many interconnected factors. Single, isolated interventions have limited impact. Multipronged and entirely new approach is required to minimize the emergence and spread of antimicrobial resistance. Greater innovation and investment are required in research and development of new antimicrobial medicines, vaccines, and diagnostic tools. Steps can be taken at all levels of society to reduce the impact and limit the spread of resistance, said a panel of experts.
According to Dr. Dipshikha Chakravarthy, associate professor, Microbiology and Cell Biology, Indian Institute of Science, Bengaluru, the bacteria and their ability to survive is unimaginable. It has a smart in-built mechanism.
Prof. Marc Devocelle, associate professor of Chemistry/Erasmus, RCSI Chemistry, Royal College of Surgeons in Ireland highlighted on the Pro drugs and Peptidomimetics of membrane active peptides research. This has created a huge demand for novel antibiotics and for this reason antimicrobial peptides (AMPs) have attracted considerable interest, since they often show broad-spectrum activity, fast killing and high cell selectivity.
The average cost for a woman with endometriosis both personally and for society is around AU$30,000 a year, according to our research, published today in the journal PLOS ONE.
Most of these costs are not from medication, or doctors’ visits, although these do play a part. Rather, they’re due to lost productivity, as women are unable to work – or work to their usual level of efficiency – while experiencing high levels of pain.
Remind me, what is endometriosis?
Chronic pelvic pain is pain below the belly button that occurs on most days for at least six months. The most common identifiable cause is endometriosis. Endometriosis is the presence and growth of tissue (called lesions) similar to the lining of the uterus that’s found outside the uterus.
Women with the condition have a variety of symptoms, including non-cyclical pelvic pain (which is like period pain but occurs regularly throughout the month), severe period pain, pain during or after sexual intercourse, and severe fatigue.
Gastrointestinal problems, such as severe bloating (often called “endo belly” by those who suffer from it) and pain with bowel motions, are also common.
Currently, surgery (a laparoscopy) is the only way to make a formal diagnosis of endometriosis – this is where a small camera is inserted into the pelvic/abdominal cavity to investigate the presence of endometriosis lesions.
Both medical and surgical treatments are commonly used for women with endometriosis. Medical therapies include non-steroidal anti-inflammatories (such as ibuprofen and naproxen), oral contraceptive pills and other forms of hormonal treatments.
Surgery is the current “gold standard” of treatment, but despite successful surgery many women find their pain and symptoms can return within about five years after surgery.
How many women have it?
Delays in diagnosis are extremely common, and combined with needing surgery for a diagnosis, means many women suffer for years with chronic pelvic pain before being diagnosed with endometriosis later in life. This contributes to the difficulty in getting exact figures for how many women in Australia have endometriosis.
Worldwide estimates of chronic pelvic pain range from 5 percent to 26 percent of women. In New Zealand, it’s around 25 percent and is likely to be similar in Australia but we are lacking any up-to-date and reliable statistics on this.
What did our study find?
We surveyed more than 400 women aged 18 to 45 who were either diagnosed with endometriosis or experiencing chronic pelvic pain. We asked about health-care costs (both out of pocket and funded), employment-related costs, and other costs related to childcare and household maintenance. We also asked about their pain levels.
We found the average cost for a woman with endometriosis was around AU$30,000 per year.
Around one-fifth of this cost was in the health sector, for medications, doctors’ visits, hospital visits, assisted reproductive technology such as IVF, and any transport costs to get to these appointments. Of this, AU$1,200 were out-of-pocket costs.
The bulk of the costs (over 80 percent) were due to lost productivity, either because of absenteeism (being off work) or presenteeism (not being as productive as usual because you’re sick). Women with endometriosis often use up all their sick leave and then often have to work when they are in severe pain.
Overall, if one in ten women aged 18 to 45 do have endometriosis, the total economic burden in Australia may be as high as AU$9.7 billion per year for endometriosis alone.
Pain scores had a very strong link with productivity costs. Women with the most severe pain had a 12-times greater loss of productivity, in terms of working hours lost, than those with minimal pain.
Overall, taking into account all costs (health sector, out-of-pocket, carers and productivity) women with severe pain have six-times greater costs (AU$36,000) a year overall compared to those with minimal pain (AU$5,700).
Finally, we also looked at the cost of illness not only of those women with a diagnosis of endometriosis, but also of those that had other causes of chronic pelvic pain, such as vulvodynia (pain, burning or discomfort in the vulva) and adenomyosis (growths in the muscular wall of the uterus).
We found the overall costs between the two groups – those with endometriosis and those with other types of pelvic pain – were very similar.
So what should we be doing?
The economic burden of endometriosis is at least as high as other chronic disease burdens such as diabetes. However, many women are not receiving the support they need.
We also need to prioritise funding for endometriosis research, which until recently has attracted comparatively little research funding.
Plans are underway to increase awareness and education, and improve diagnosis and pain management. Unfortunately, there is no such plan for women with other forms of chronic pelvic pain.
Reducing pain, by even a modest 10-20 percent, could improve women’s quality of life and potentially save billions of dollars each year.
The Indian Pharmaceutical Market (IPM) has registered a growth of 11.9 per cent for the month of September 2019 as against August month growth of 9.4 per cent. According to AIOCD AWACS report, the IPM has recorded sales of Rs. 136,802 crore and a growth of 9.8 per cent for Moving Annual Total (MAT) basis during September 2019.
Among the top 50 corporates, 33 corporates exhibited double digit growth. Among the top 50 corporates, 49 corporates exhibited positive growth for the month of September, 2019.
Amongst the top 10 corporates, Glaxo exhibits highest growth of 22.9 %, followed by Lupin (19.3%) and Torrent (17.5%). Amongst the 11-20 ranked Corporates, Dr Reddys exhibits highest growth (24%) followed by Aristo (21.3%) and Emcure + Zuventus (17.9%). Amongst the 21-30 ranked Corporates, FDC exhibits highest growth (19.7%), followed by Himalaya (16.6%) and Indoco remedies (13.9%)
Amongst the 31-40 ranked corporates, La Renon exhibits the highest growth (35.5%) followed by JB Chemicals (28.1%) and Medley (16.8%). Amongst the 41-50 ranked Corporates, Boehringer Ingelheim exhibits the highest growth (45.5%), followed by Corona (30.7%) and Fourrts (25%).
Amongst the 51-60 ranked corporates, Fresenius Kabi exhibits the highest growth (28.2%) followed by Pharmed (24.8%).Amongst the 61-70 ranked Corporates Danone exhibits the highest growth (28.8%), followed by Eli Lilly (22.9%) and Tablets India (22%)
Amongst the 71-80 ranked corporates, Leeford HC exhibits the highest growth (25.9%), followed by Oaknet HC (19.2%) and KLM Labs (11.9%). Amongst the 81 -90 ranked Corporates Samarth exhibits highest growth (24.3%), followed by Roche (21.5%) and Walter Bushnell (11.5%)
Amongst the 91 -100 ranked corporates, Alniche LS exhibits the highest growth (20.7%), followed by Torque (15.5%)
Amongst the 101 -150 few of the corporates exhibiting double digit growths are Linux Labs, Gland, Juggat, Icpa Health, Paviour, Innovcare, Unison, Entod, Deys Medical, Celon Labs, Group, Finecure Pharma, Comed, Galpha, Dabur, MSN, Menarini India, Seagull, Reckitt Benckiser, Johnson & Johnson, Icon, Lekar, Stadmed, Overseas
Among the top 10 companies, Torrent, Lupin, Abbott, Sun exhibits high growth momentum in September. Cipla, Mankind, Alkem seems to have slowed down for the month, Zydus Cadila, Glaxo appears to be steady. Dr Reddys, Emcure growth have picked up in recent months.
For the month of September, multinational companies were exhibiting a growth of 13.5%, whereas Indian companies were exhibiting a relatively lower growth of 11.6%.
Amongst the top MNC’s Boehringer Ingelheim (45.5%) exhibits the highest growth followed by Danone (28.8%), Glaxo (22.9%), Astra Zeneca (19.5%), Janssen (17.8%), Sanofi India (11.4%).
FDC related market showed negative growth of -66.5%.While the approved FDC market showed a growth of 12.3% and the single molecules grew at 12.5% for the month September-19.
The approved FDC component growth drivers are volumes at 2.7%, prices at 6.2%, while new introduction exhibits a high growth of 3.4%. The single molecules growth drivers are volumes 5.1%, price growth of 5% and new introductions at 2.4%.
The NLEM 2013 containing molecules market showed growth at 13.2%, whereas the non NLEM market grew at 11.8 % resulting in an overall growth of 11.9 % for the month of September 19
Few major brands, which has gained in ranks for the month are Augmentin gains 5 ranks for the month, Becosules gains 5 rank, Phensedyl Cough Linctus gains 20 ranks, Orofer XT gains 14 ranks, Synflorix gains 14 ranks, Rosuvas gains 9 ranks, Udiliv gains 9 ranks, Telma gains 8 ranks, Volini gains 5 ranks, Calpol gains 10 ranks, Manforce gains 12 ranks, Taxim O gains 10 ranks, Betnovate C gains 42 ranks
Few major Brands who have dropped in ranks are Galvus met (-15), Lantus (-4), Foracort (-4), Pan (-3), Pan D (-8), Istamet (-11), Sinarest (-8).
There were 251 brands launched in the month of September 19, which has added 5 crore incremental sales in the market.
As of MAT Sep 19 patented and in-licenced brands contribute to 4.34% of IPM and contributes to 5.9% of the incremental gains in the IPM.
From therapy (Super Group) perspective 17 therapies (anti -infectives, gastro intestinal, pain/analgesics, vitamins/minerals/nutrients, cardiology, anti-diabetics, neuro/cns, derma, urology, blood related, sex stimulants/rejuvenators, stomatologicals, anti-malarial, vaccines, opthal/otologicals, hormones, anti-neoplastics are exhibiting double digit growth for the month of September-19.
From the regional perspective 23 out of 30 regions exhibits double digit growths.
South AP market grew the highest at 53.09%, followed by Jharkhand (52.3%), South Karnataka (36.19%), North Karnataka (36.1%), Telangana (33.18%) for the month of September 19.
Amoxycillin + clavulanic acid market ( Rs. 2,188 crore) exhibited a growth of 14%, followed by paracetamol market (Rs. 1,118 crore) which exhibited a growth of 23%; domperidone + pantoprazole market (Rs. 935 crore) exhibited growth of 12%, itraconazole market (Rs. 926 crore) have slowed down to 8%, sofosbuvir + velpatasvir market (Rs. 338 crore) is exhibiting degrowth (-29%).
Glimepiride + metformin market (Rs. 2,375 crore) exhibited a growth of 11% for the month, While tenegliptin + metformin (572 crore) exhibits growth of 34%, teneligliptin plain (Rs. 439 crore) is exhibiting growth of 14%, voglibose + metformin + glimepiride market (Rs. 787 crore) has posted a double digit growth of 24%, vildagliptin + metformin market (Rs. 745 crore) exhibits degrowth (-19%).
Rosuvastatin (Rs. 923 crore) plain market exhibited growth of 18%, atorvastatin plain market (Rs. 832 crore) is exhibiting growth of 11%. The luliconazole market (Rs. 426 crore) is exhibiting a growth of 14%.
Probiotic microbes market (Rs 368 crore) is exhibiting a growth of 21% and probiotics with multivitamin & mineral market (Rs. 47 crore) is exhibiting a growth of 23%, pantoprazole plain market (Rs. 1,010 crore) is exhibiting a growth of 15% while pantoprazole + domperidone combination (Rs. 935 crore) is exhibiting a growth of 12%. montelukast + levocetrizine (Rs. 808 crore) is exhibiting growth of 12%.
SGLT2I market is now valued at Rs. 923 crore and is exhibiting growth of 70%, remogliflozin registers Rs. 14 crore in sales value as of MAT September; The valsartan + sacubitril market is valued at rs. 225 crore exhibiting growth of 68%;
The vildagliptin market valued at rs. 997 crore has exhibited degrowth (-14%) for the month.