DTx Product Case Study: Propeller®

Propeller has demonstrated in asthma a 58% increase in medication adherence, 78% reduction in rescue inhaler use and a 63% increase in asthma control

Digital therapeutics (DTx) deliver evidence-based therapeutic interventions to patients that are driven by high quality software programs to prevent, manage, or treat a medical disorder or disease. They are used independently or in concert with medications, devices, or other therapies to optimize patient care and health outcomes.

Product Overview

Medical condition:

Asthma and COPD

Target patient population:

Patients with persistent asthma and patients with Stage II-IV COPD.

What to expect:

Consistent levels of high medication adherence, consistent improvement in disease control, and reductions in Emergency Department visits and hospitalizations.

Clinical
Overview

Indications for use:

Propeller’s digital platform helps asthma and COPD patients and their healthcare providers record and monitor medication usage, review symptoms, and receive personalized information about their disease management and its impact.

When used under the care of a physician with a compatible inhaled medication, the system can be used to reduce the frequency of respiratory health symptoms and exacerbations by increasing adherence through the use of feedback such as reminders and notifications, and self-management education.

Outcomes:

Research has demonstrated that Propeller increases medication adherence by up to 58%, reduces rescue inhaler use by up to 78%, and reduces asthma- and COPD-related ED visits and hospitalizations by up to 57% and 35% respectively.

Directions:

Patients use Propeller by attaching a sensor to their existing inhaler. The sensor tracks medication usage and location data and sends that information to an app on the patient’s smartphone. Propeller builds a personalized profile including symptom triggers and disease management tips to help them self-manage their disease. It also provides medication adherence reminders, air quality forecasts, in-app medication refills, shareable progress reports, and a lost-inhaler locator.

Risks & warnings:

This sensor is not meant to communicate emergencies. Sensor information can be delayed, and your care team may not be aware of your condition. If your sensor interferes in any way with use of your inhaler, remove your sensor. Do not put the sensor underwater. Never delay using your inhaler in order to attach your sensor. Do not try to remove the battery from the sensor or service the sensor. The sensor is not a dose counter. Choking hazard; keep away from small children.

Place in therapy:

Complementary to current medication therapy

Product
Access

Product description:

Propeller uses small sensors that attach to patients’ medication inhalers. The sensors are paired with a smartphone app to automatically track medication use and provide personal feedback and insights that help individuals and their doctors manage and reduce symptoms. Propeller data can be accessed by healthcare professionals through a portal or API.

Prescription status:

A prescription is not required.

Patient access:

Depending on the program, patients enroll in Propeller on a Propeller website, in the Propeller app, or a similar enrollment process either directly or through a referral from their healthcare insurer, provider or pharmaceutical company. Once a patient has enrolled and signed in to the app, they are mailed a sensor to attach to their inhaler.

Use of the product requires access to:

  • Internet or wifi
  • A mobile phone, or computer

Provider access:

Healthcare providers can use the Propeller Provider Portal to remotely monitor patients’ controller medication adherence and rescue medication usage as well as to receive notifications when patients are at increased risk of exacerbations.

Coverage options:

Propeller is made available through grants and partnerships with payers, providers, and PBMs.

Product availability:

Propeller is available in:

  • USA: FDA-cleared Class II Medical Device
  • Canada: Class I Medical Device
  • EU: Class I Medical Device

A Day in the Life with Propeller®

Over 100,000 patients have signed up for Propeller, more than any other digital therapeutic in the respiratory space.

Clinical
Trials

Study Title: Effectiveness of Population Health Management Using the Propeller Health Asthma Platform: A Randomized Clinical Trial

Features: A total of 495 patients were enrolled in parallel arms (1:1) for 12 months of monitoring SABA use. Intervention group (IG) patients received access to and feedback from the Propeller Health system. Routine care (RC) patients were outfitted with sensors but did not receive feedback. Physicians were able to monitor the status of their patients in the IG and receive proactive notifications.

Outcomes: Compared with routine care, the study arm monitoring SABA use with the Propeller Health system significantly decreased SABA use, increased SABA-free days and improved ACT scores (the latter among adults initially lacking asthma control).

Study Title: Interim Results of the Impact of a Digital Health Intervention on Asthma Healthcare Utilization, Journal of Allergy and Clinical Immunology

Features: We compared asthma-related and non-asthma-related utilization event rates among patients during the intervention period to those during their pre-intervention baseline. We collected utilization data from EMRs between July 2012 and September 2015. Differences from baseline in rates per 100 patients per year were assessed using a Wilcoxon Signed Rank test.

Outcomes: A digital health intervention significantly reduced asthma-related acute healthcare utilization, including ER visits and hospitalization. An increase in clinic visits suggests providers attempted to address patient worsening in a non-acute setting before an acute exacerbation occurred.

Study Title: Overuse of short-acting beta-agonist bronchodilators in COPD during periods of clinical stability

Features: Prospective 3-month cohort study of patients with moderate-to-severe COPD who were provided a portable electronic inhaler sensor to monitor daily SABA use.

Outcomes: Increased use of SABA was common and associated with increased disease severity and symptoms, even though increased users were on more COPD-related inhalers and more had completed pulmonary rehabilitation. More research is needed to understand factors associated with increased inhaler use and how to improve correct inhaler use.

Study Title: Feasibility and Clinical Impact of Deploying a Digital Health Intervention on a Medicare Population with Asthma or Chronic Obstructive Pulmonary Disease (COPD)

Features: Participants were enrolled in a single arm, pre-post digital health pilot study at the JenCare clinic in Louisville, Kentucky. Participants were eligible with a diagnosis of asthma or COPD and a compatible short-acting beta agonist (SABA) medication.

Outcomes: A digital health intervention was feasible and effective among an older, diverse Medicare population. Participants demonstrated high activation and retention rates, significantly reduced SABA use and more symptom-free days.

Study Title: Feasibility of Deploying Inhaler Sensors to Identify the Impacts of Environmental Triggers and Built Environment Factors on Asthma Short‑Acting Bronchodilator Use

Features: We utilized zero-truncated negative binomial models to identify triggers associated with inhaler use, and implemented three sensitivity analyses to validate our findings.

Outcomes: Utilizing a sensor to capture the signal of rescue inhaler use in space–time offered a passive and objective signal of asthma activity. This approach enabled detailed analyses to identify environmental triggers and built environment factors that are associated with asthma symptoms beyond the residential address. The application of these new technologies has the potential to improve our surveillance and understanding of asthma.

Study Title: Patient Reported Value and Usability of a Digital Health Intervention for Asthma

Features: Surveys administered to participants of a randomized controlled clinical study designed to measure the clinical effectiveness of the Propeller Health Asthma Platform.

Outcomes:  Respondents (n=89) reported being very satisfied (79%) or somewhat satisfied (20%) with the inhaler sensor, stating that the sensor was “small,” “unobtrusive,” and “easy to use” and carry. A total of 90% of respondents found the information they received via the platform useful, with 93% expressing satisfaction with the information.

Study Title: Remote Monitoring of Inhaled Bronchodilator Use and Weekly Feedback about Asthma Management: An OpenGroup, Short-Term Pilot Study of the Impact on Asthma Control

Features: Through an investigational electronic medication sensor attached to each participant’s inhaler, the study monitored 4 months’ use of inhaled, short-acting bronchodilators. Participants completed surveys, including the Asthma Control Test™, to assess asthma control at entry and monthly thereafter.

Outcomes:  Weekly email reports and access to online charts summarizing remote monitoring of inhaled bronchodilator frequency and location were associated with improved asthma control and a decline in day-to-day asthma symptoms.

Study Title: Randomized, controlled study of the impact of a mobile health tool on asthma SABA use, control and adherence

Features:  This mobile health program, with sensor-enabled data collection and patient and provider access to the data, improved asthma outcomes, including asthma SABA use, control, and adherence in a real-world clinical setting.

Outcomes:  Adult patients with asthma and a SABA prescription were enrolled (n=125). Participants randomized to the intervention group (IG) (n=67) received electronic inhaler sensors to track their medication use, and access to smartphone and online applications that provided visualizations of their data, reminders to promote adherence, and personalized, guidelines-based education. Clinical care managers viewed IG patients’ data in an online dashboard to guide care. Participants in the control group (CG) (n=58) received sensors, but neither the patient nor the care manager received access to their data. Mixed effects regression models with random intercepts were used to compare outcomes between groups at 6 months.