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Keeping Tabs On Patients

January 12, 1995

NEW YORK (AP) _ A tiny computer embedded in a drug bottle cap is a small high-tech firm’s answer to one of medicine’s most vexing problems _ patients who don’t take their prescriptions.

The SmartCap, made by Aprex Corp. in California’s Silicon Valley, has a digital readout telling you how many times you remove it each day, and when, and it beeps when it’s time to take your pills.

Aprex is combining the cap with a computer modem, attached to a telephone, that lets you transmit your dosing habits to the company each day. Aprex will phone you with a polite reminder whenever you miss your drug regimen.

The system known as Dosing Partners, to be formally unveiled by the company on Thursday, will be marketed to insurers and health care plans as a way to cut costs and make patients healthier.

``We’re not big brother. We’ll only take volunteers. And we’re not their mother, we’re not going to nag. What we’re going to do is empower people to be successful with their medication taking,″ Aprex chairwoman and chief executive Janice Wohltmann said Wednesday.

Pharmaceutical experts were mixed on the idea, balking at its $75 a month average cost and noting that other less sophisticated dosing reminders have failed. Still, they said it held some potential.

``Private entrepreneurs have put down money to develop it and are selling it to private, profit-oriented entrepreneurs. If it meets that test, who could possibly object to it?″ said Uwe Reinhardt, a professor of health care economics at Princeton University.

Aprex (the name stands for `after prescription’), is a privately owned company founded in 1985 and based in Fremont, Calif., near San Francisco.

Its SmartCap has thus far been used mostly by major drug companies that are administering experimental medications to people and need to document precisely when they’re taken.

Dosing Partners represents Aprex’s first foray into consumer products.

Numerous medical studies have shown that patients’ failure to take drugs costs the health care system tens of billions of dollars a year, resulting in unnecessary medical tests, operations and deaths.

``The cost of a kidney transplant that works is about $65,000. The leading cause of kidney transplant rejection in the United States is that patients don’t take their immunosuppressant properly,″ said Wohltmann. ``A kidney that’s rejected can cost almost a quarter of a million dollars.″

Yet, even if they have serious chronic conditions such as congestive heart failure, epilepsy, diabetes, asthma, and cancer, these patients fail to take their drugs half the time or more, doctors generally concede.

The reasons vary _ forgetfulness, disease denial, side effects or simply cost. Aprex is targeting these chronic disease patients who need to take drugs for the long term, often several times a day.

Of course, the SmartCap only knows if patients open the bottle _ not that they actually take the pills. But Wohltmann expressed doubts that many patients will defeat it.

Each evening, the patient places the bottle on top of a small computer modem about the size of a TV remote control. The modem then transmits the daily dosage times over a toll-free telephone line to Aprex. If the drug wasn’t taken in the proper intervals, an Aprex staffer phones the patient the next day.

At the end of the month, Aprex will mail a printout of the dosages to the patient’s doctor.

Herb Rich, who ran a drug store for 28 years and now teaches at the Philadelphia College of Pharmacy, was skeptical. He doubted many insurance companies would pay the $2.50 a day cost and was unsure if the people who need it the most _ the elderly _ will be comfortable with the technology.

``If you could get people who aren’t compliant into compliance it would be worth $22.50 a day, but I don’t think they will use it.″

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