Cracking The Code Behind Patient Adherence

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PMRG Spring 2005 Conference May 10, 2005
TheraScoreTM
Cracking The Code Behind Patient Adherence David
Hoo John Nives
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Industry Problem Poor Patient Adherence

• Costs an estimated 30 Billion in lost sales
  annually
• After MDs initial Rx, patient adherence
  determines utilization

• Patient Beliefs
• Adverse Drug Side Effects
• Complicated Regimen
• Behavioral
• Financial Barriers
• Lack of Understanding
• Wellness
• Physician Relationship

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The Research Problem
Disjointed View of Patients
Ad Hoc ATU Surveys Focus Groups
Anonymous Patient Level Data
Data on what, not why or who.
Data on why from claimed behavior.

• De-identified patients cannot be surveyed
• Demographics limited to patient age/sex
• Physician-only identification has limitations
  (Product/Dosage/Physician Specialty)

• Point-in-time sample does not provide full
  understanding of changes over time
• Claimed purchase behavior relies on accurate date
  quantity of filling scripts

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The Solution Integrate Attitudes With Behavior
Integrated Behavioral Attitudinal Information
Side Effect Issue
Physician Recommended

• Disease-Specific Patient Panels
• 10-15K individual sample
• Longitudinal Pharmacy Claims Data
• 2 years back data
• Monthly forward tracking
• Monthly Online Surveys Linking
• Attitudes
• Behaviors
• Characteristics

Patient Request
Patient Request
Physician Recommended
Brand B
Attitudinal Surveys
Patient Level Data
Brand A
Brand A
Brand B
Brand A
Patient bought Brand A based on their physicians
prescription.
Brand A
Side Effect Issue
After 3 months, the patient renewed their script
but began suffering side effects.
After lapsing, patient visited physician again,
requesting Brand B as an alternative.
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Measuring Patient Attitudes Over Time
Retain.
Expand.
Acquire.

• Why Do My Patients Stop Their Treatment?
• Who are the Most Persistent Patients and Why?
• What Are the Attitudes/Behaviors of My Most
  Loyal Patients?

• Did the Patient Request A Specific Drug From
  Their Doctor?
• Did the Physician Fulfill the Patient Request?
• What is the Patient Takeaway from the Physician
  Dialogue?
• How Does Patient Education Drive Compliance?

• How Do Patients Learn About Their Condition?
• Who Are the Best Prospects to Target with DTC
  Advertising?
• What DTC Messages Are the Most Compelling to
  Consumers?

Patient Awareness Education
Long Term Script Usage
Doctor Visitation
Coping Behavior
Doctor Patient Dialogue
Script Issued
Fulfillment of Script
Initial Script Usage
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Hypertension Compliance Analysis
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TheraScore - Hypertension Panel 10K Patients
Phase II
Phase I
Personal Health Profile
In-Depth Attitudinal
Pharmacy Claims Data
Demographics
Monthly Forward Tracking

• Forward Rx Data
• Rx/OTC Usage
• Physician Interactions
• Non-Adherence Switching Reasons
• Samples/Other Purchases

• Demographics
• Co-Morbidities
• Insurance Coverage

• Opinions Beliefs
• Condition
• Medications
• Outcomes
• Physician
• Patient Role
• Non-Adherence Reasons
• Other Key Characteristics

• Health Profile Lifestyle
• Diagnosis, Symptoms Severity
• Treatment Satisfaction
• Efficacy
• Side Effects
• Cost
• Convenience
• Impact on QOL

• 2 Years Back Data
• Rx Product
• Date Dispensed
• Rejected Rxs
• Days Supply
• Form Strength
• Quantity
• Package Size
• Cost
• Payment Type
• Patient Paid)
• Copay Amount
• Refills Authorized
• New/Refill Rx
• Plan Name

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Adherence Measurement Analysis

• Phase I
• Compliance Patient adherence to MDs
  specific prescribed dosing
• Measured as the Medication Possession Ratio (MPR)
• Days Supply/Days on Therapy
• Example 120 Days Supply/180 Days Therapy
  67 MPR
• Analyzed two levels
• More Compliant (MPR gt80)
• Less Compliant (MPR lt80)
• Phase II
• Persistency How long patients remain on therapy
  

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Antihypertensive Non-Compliance
Calcium Channel Blockers (CCB) users are
significantly less compliant than ACE Inhibitor
(ACI) users
lt 80 Medication Possession Ratio
Arrow(s) indicate statistical difference at 95
confidence level.
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Patient Demographics
CCB and ACI users are the same population
demographically
Mean Age
Gender
Female 70
Female 72
Years
Male 30
Male 28
Income
Dollars
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Patient Attitudes Toward Condition Severity
Attitudinally Assess Patient Severity with
Measurements Linked to Actual Rx Utilization
But CCB users perceive their condition to be more
severe, have greater difficulty controlling their
HBP and visit the ER more often.
Mean Attitudinal Rating
Arrow(s) indicate statistical difference at 95
confidence level.
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Target Organ Damage
CCB users have significantly more organ damage.
1 target organ damage 0 No target organ damage
Arrow(s) indicate statistical difference at 95
confidence level.
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Patient Satisfaction Ratings
Compared to the ratings ACI users give their
medications, CCB users rate CCB medication as
less efficacious and more costly.
Mean Attitudinal Rating
Arrow(s) indicate statistical difference at 95
confidence level.
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Non-Compliant vs. Compliant Patients
Non-compliant CCB users are significantly younger
than compliant users
Mean Age
Gender
Female 70
Female 70
Years
Male 30
Male 30
Income Level
Arrow(s) indicate statistical difference at 95
confidence level.
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Lifestyle Body Mass Index Weight
Score Height and Weight as Clinically Relevant
Body Mass Indices All Linked to Actual Rx
Utilization
Non-compliant CCB users are significantly more
obese than compliant ones.
Body Mass Index
Weight Category
Body Mass Index
Compliant Non-Compliant
Weight Category score classified under wt 0, 1
normal, 2 over wt, 3 obese
Arrow(s) indicate statistical difference at 95
confidence level.
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Patient Satisfaction Ratings
Non-compliant CCB users suffer significantly more
from side effects.
Mean Attitudinal Rating
Mean Attitudinal Rating
Compliant Non-Compliant
Arrow(s) indicate statistical difference at a 95
confidence level or higher.
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Fainting/Dizziness Occurrences
Non-compliant CCB users experience significantly
more symptoms of dizziness due to hot weather and
exercise than compliant users.
Compliant Non-Compliant
Mean
Experience 1Do / Not Experience 0
Arrow(s) indicate statistical difference at a 95
confidence level or higher.
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Lifestyle Modifications Pursued
Non-compliant CCB users who are obese pursue
weight reduction and other non-medication
treatments. They are less likely to quit smoking.
Compliant Non-Compliant
Attitudinal Rating
Arrow(s) indicate statistical difference at 95
confidence level.
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The Value of Patient Segments

• The less severe and non-obese patients actually
  have the highest utilization followed by the less
  severe obese patient. The former probably has
  better efficacy while the latter needs the drug
  more.

Attitudinal Data is of Unknown Value Without
Actual Rx Utilization Volumetric Data Enables
Marketers to Calculate Patient Value and
Marketing ROI And Select the Optimal Target
Segments
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Patient Segment Demographics Targeting
Patient Segmentation Is Not Worth Much If You
Dont Know how to Effectively and Efficiently
Target the Opportunity
Non-compliant and obese CCB patients tend to be
older, male, among larger households and African
American.
HBP Non-Compliant Suffer
ers Obese CCB
Index vs. Sufferers
Age 18-44 36
24 45-64 56
59 65
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18 Gender Female
75 56 Male 25
44 Avg. Household Size 2.9
3.8 Education Post College
8 7 Some
College/College Grad 63 65 High
School Grad 25
25 Grade
School/Some High Sch 4
2 Race White
83 83 Black
11 13 Other
6
4
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Translating Insights into Marketing Tactics

• Findings
• CCB patients suffer more severe hypertension and
  are less satisfied with efficacy than ACI
  patients.
• Non-compliant CCB patients experience greater
  side effects and are more obese. They are skewed
  demographically, report dizziness due to exercise
  and pursue non-drug treatments for hypertension.
  
• Indicated Tactics
• Enhance the perceived efficacy of CCB patients by
  aggressively putting them on weight reduction
  programs that initially emphasize diet with more
  gradually increased focus on exercise.
• Develop physician detailing program to win
  physician support, branded patient education
  materials, weight reduction/adherence website
  program and patient tracking.
• Branded combined lifestyle modification and drug
  treatment program will produce better outcomes
  and patients will perceive an enhanced CCB
  therapeutic profile.

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Next Generation Patient Measurement Applied To
Segmentation Targeting and Messaging
Patient Channel Marketing Application Physicians
Detail Aids/Sales Call Messages   Patent
Education Materials Patient Sample Pack
Design Direct Marketing Targeted Mailings
Website Content Score Patient
Database Targeted E-mailings
Score New Mailing Lists Mass Media DTC
Advertising Message   TV/Radio/Print Media Plan
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What Cracking the Code Means For You
Asthma/COPD
Allergy
Hypertension
Pain/Arthritis
Cholesterol
Migraine

• Problem Poor patient adherence means 30 billion
  in lost sales
• New, superior patient intelligence supplies
• the whos and whys behind non-adherence
• Improved marketing strategy and tactics across
  patient channels
• Increased Adherence
• Expanded Sales/Bottom Line and Improved Patient
  Wellness

For every 1 increase in adherence the industry
gains 300 million in sales
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Thank You. Questions?The TheraScore Team thanks
The DTC National for this speaking opportunity.
The team also wishes to acknowledge the key
contributions of people
at AC Nielsen, Marketing
Technology Solutions and Foresight Consulting
for the analysis
included in this presentation.
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Contact Us for More Information
David Hoo Director Rx/OTC PanelsACNielsen516.682
.6109 david.hoo_at_acnielsen.com
John Nives Vice President, Information Services
Division Marketing Technology Solutions 917.256.04
82 x224 jnives_at_mateso.com
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PBIRG Annual General Meeting 2005Research
Excellence Case Study
Identifying Removing Barriers to Expanded
Product Use
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Setting the Stage
Main Objective Hone strategy for EU launch of
product

• Key Issue Product challenges existing in US
  domestic market

Our sales reps are having problems effectively
addressing physicians concerns about Product
X.
Considerations
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Our Approach
Research Interests

Conduct US study to add value to previous
global market research and guide EU launch
plans Results would also serve interest of US
team

• Spin on areas to investigate
• Uncover obstacles to positive perceptions
• Determine how to correct negative perceptions
• Segment results to gain different levels of
  insight

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Core Methodology

• Self-completion Internet survey among physicians
  
• US sample (200 primary care and 100 specialists)
• Questionnaire length 20 minutes
• Timeline

Survey design lt 1 week Fieldwork 4
days Results available lt 1 week following
fieldwork
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Themes Guiding Our Research Design
Uncover and measure impact of BARRIERS
Take insights to the next level with
actual SOLUTIONS
Explore results by physician SUBGROUPS
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Results of Our Research
Quantified barriers to product adoption
expanded use Established relationships barriers
physician subgroups Pinpointed effective
solutions to remove each barrier
Tactical
Honed brand launch plans for Europe Identified
way to counter post-launch barriers in EU
markets Prioritized future research needs
(marketing clinical)
Strategic

• Global US teams developed actionable plans
  based on quantitative data

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SOME RESULTSIdentifying Removing Barriers to
Expanded Product Use
(Case Study)
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Barrier Gap Matrix
Barrier Impact on Script Volume for Product X
HIGH
LOW
HIGH
Poor symptom control as monotherapy
Cost is prohibitive
Secondary Focus
Barriers Level 4
Inferior when used in patients with co-morbid
diabetes
Dosing schedule inconvenient for patients
Concerns regarding long term safety
Concern with Barrier Across Entire Class
Not top-of-mind when thinking about 1st line
therapy for condition
High proportion of patients experience GI
problems
First Priorities
Barriers Level 3
Does not work well in combination with Class Y
Inferior when used in patient with history of MI
Frequent episodes of headache as a side effect
LOW
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Physician Segment Barrier Summary
Product X Users by Rx Decile
Barriers
High
Mod
Low
Does not work well in combination with Class Y
Doesn't work well in combination with Class Y
Dosing schedule inconvenient for patients
Tier I
Poor symptom control as monotherapy
Not top-of-mind when thinking about first line
therapy for condition
Not top-of-mind when thinking about first line
therapy for condition
Inferior when used in patients with history of MI
Inferior when used in patients with co-morbid
diabetes
Tier II
High proportion of patients experience GI
problems
Frequent episodes of headache as side effect
Cost is prohibitive
Tier III
Concerns about long term safety
Size of circles degree of barrier to increased
use of Product X
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Identification of Countermeasures

• Working within the tight timelines for this
  study, cues taken from the brand team regarding
  what might be done to correct existing
  misconceptions, as well as valid concerns about
  their product
• Brainstorming session included representatives
  from MR and Marketing - US and Global

OBJECTIVE Derive a list of potentially
effective, yet realistic countermeasures
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Types of Countermeasures

• A range of potential countermeasures to correct
  disappointing product uptake were brought to the
  table
• Various categories were evoked

Some fairly immediate correctives, others
requiring medium to long term planning efforts
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Countermeasure Effectiveness
Top Priority Barrier Does not work well in
combination w/ class Y
Barrier reduction Index (1-100)
Claim B
Claim C
Claim A
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Cumulative Countermeasure Index Average
Countermeasure Effectiveness for Appropriate
Barrier(s)
BARRIERS 1. Dosing schedule inconvenient for
patients 2. High patients experience GI
problems 3. Frequent episodes of HA side effects
Cumulative Countermeasure Index (1-70)
Patient Starter Kit
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The Results in a Nutshell
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HOW THE RESULTS WERE USED Identifying Removing
Barriers to Expanded Product Use(Case Study)
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Insights Gained
Sanity check of global product strategy Cross-refe
rence with perceptual data Refine global
positioning Address country-specific hurdles
Optimize clinical trials Roll-out of existing
data Design and planning of future trials
Fine-tune promotional materials Detail
aids Objection handlers
Incorporate into rep training materials
Tailor individual detailing visits
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Refined Sales Force Strategy
BEFORE
AFTER

Identify physicians concerns about Product X
DURING DETAIL VISIT
Identify physicians concerns about Product X
PRIOR TO DETAIL VISIT
Cost is prohibitive
Dosing schedule inconvenient for patients
Poor symptom control as monotherapy
Try to counter barriers with LIMITED materials
on hand
Counter barriers RELEVANT to each physician with
TARGETED materials
Hope the time spent in office translates to
increased use of product
Leave confident that time spent in office will
have high ROI
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In Conclusion
The results of this market research project were
used in a multitude of ways to break through
barriers and expand usage of Product X by
prioritizing tactics and strategies to overcome
segment-specific obstacles.
THANK YOU!