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Patient support programmes within medicines optimisation – the pros and cons
Andy Carter | Director of StrategyAtlantis Healthcare
Patient Support Programmes within medicines optimisation
“Good commercial value or bad investment”
Andy CarterDirector of Strategy, Atlantis Healthcare
Adherence to long-term therapy for chronic illnesses in developed countries
averages 50%. In developing countries, the rates are even lower1
1. WHO: adherence to long-term therapies: Evidence for action. 2003
1. IMS Institute for Healthcare Informatics – Advancing the responsible use of medicines: Applying levers for change, Oct 2012
The health spending that can be avoided in this way amounts to 8% of total annual health expenditures worldwide1
"Responsible" meds use can save $500B/year globally
More than half ($269B) can be gained through improved patient adherence, according to the report1
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Medication optimisation is on the UK’s agenda
Royal Pharmaceutical SocietyMedicines Optimisation: Helping patients to make the most of medicines May 2013
CG76 Medicines adherence: NICE guideline Jan 2009
£300m medicines wastage v’s £500m/year estimated opportunity cost of health gains foregone due to meds optimisation1
1.York Health Economics Consortium & the school of pharmacy, university of London, Evaluation of the scale, causes and costs waste medicines 2010
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Pharma investment reacting to medicines optimisation agenda
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Non adherence transcends all conditions
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Cochrane - acknowledges the importance of medication adherence
“Effective ways to help people follow medical treatments could have
far larger effects on health than any treatment itself”
1.Cochrane review: “Interventions for enhancing medication adherence” 2008
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Poor adherence is costing pharma hugely in lost revenue
Even a modest 10% increase in adherence could lead to a significant rise in revenues, accompanied by improved health outcomes and decreased
healthcare spending.
Global pharmaceutical market revenue loss is estimated to be $564 billion, or 59% of total global pharmaceutical revenue in 2011
Firlik K et al, Estimated Annual Pharmaceutical Revenue Loss Due to Medication Non-Adherence, Nov 12
The evidence to date
Patient adherence interventions / support
Inconclusive findings - but acknowledged scarcity of evidence
Haynes et al, Interventions for enhancing medication adherence. Cochrane database of systemic reviews 2008, Issue 2
Authors’ conclusions:
“For short term treatments, several quite simple interventions increased adherence & improved patient outcomes, but the effects were inconsistent from study to
study.”
“For chronic conditions, interventions are mostly complex and not very effective.”
Short term treatments - 5/10 interventions improved adherence- 4/10 interventions improved clinical outcomes
Long-term treatments - 36/83 (43%) interventions improved adherence - 26/83 (31%) interventions improved clinical outcomes
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A consistent weakness in research to date around adherence
NHS – SDO CRITICAL REVIEWHorne, Weinman et al, 2006
• A narrow focus & failure to consider both intentional and unintentional non adherence
• “One-size-fits-all approach” (i.e. not personalised)
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Perceptions & health beliefs drive intentional non-adherence
The impact of personalised interventionsProduct All preventer inhalersProgramme name Asthma AIMPublication Published British Journal of
Health Psychology
Overview
• A scalable intervention programme designed to increase adherence to asthma preventative medication
• Programme developed in conjunction with the University of Auckland and supported by Vodafone
• Programme conducted as part of a randomised controlled trial (RCT)
• Programme comprises 18 week text message package tailored to the individual’s illness perceptions & medication beliefs
A study targeting patient beliefs to improve adherence
Improved adherence in asthma intervention group
Adhe
renc
e %
Average adherence over all time points was 43.2% in control group v’s 57.8% in intervention group
Keith J. Petrie, 2012, A Text Message Programme Designed to Modify Patients’ Illness and Treatment Beliefs improves Self-Reported, Adherence to Asthma Preventer Medication, British Journal of Health Psychology 17, 74-84.
Personalised programmes can deliver lasting behaviour change
Baseline 6 Weeks 12 Weeks 18 Weeks 6 Months 9 months0
10
20
30
40
50
60
70
Control Intervention Group
Aver
age
Adhe
renc
e %
Intervention ceases at 18 weeks, adherent behaviour continues
Average adherence over all time points was 43.2% in control group v’s 57.8% in intervention group
Keith J. Petrie, 2012, A Text Message Programme Designed to Modify Patients’ Illness and Treatment Beliefs improves Self-Reported, Adherence to Asthma Preventer Medication, British Journal of Health Psychology 17, 74-84.
Patient support programmes with personalised interventions
- Delivering positive ROI
HCP’s differentiate brands with patient support programme
Specialist physicians surveyed - 61% stated the availability of the patient
support programme would likely impact on their choice of treatment
Independent market research 2013 – data on file
Patient support programmePatients with wet age related macular degeneration (AMD)
12 month patient support. Interventions included:- seminars- nurse calls- welcome packs for carers & patients- Self monitoring tools- DVD’s & Audio
Strategy 1. Empower patients to take control2. Create a patient support programme that is valued by patients and is recognised
by HCP’s3. Differentiate product from its competitors
Atlantis Healthcare - Data on file
Programme running for 5 years due to positive commercial return
Commercial return prolific
• 8 fold decrease in drop out – 3% of patients on the program discontinued treatment versus 24% not on the program
• Patients on the program have on average 2.5 additional scripts per annum
• 3,000 patients enrolled
• ROI = 941%
Average number of treatments per time period
n 3 mths 6 mths 9 mths 12 mths 15 mths
Non PSP 2645 2.78 4.30 5.38 6.22 7.00
PSP 316 3.20 5.52 7.21 8.70 10.38
Atlantis Healthcare - Data on file
The ability to develop value propositions
Roebuck C, Liberman J, Gemmill-Toyama M et al. Medication adherence leads to lower health care use and costs despite increased drug spending. Health Affairs, 30, no.1 (2011):91-99
Therapy area Return on investmentChronic heart failure 8.4 : 1Hypertension 10.1 : 1Diabetes 6.7 : 1Dyslipidaemia 3.1 : 1
Key learnings & recommendations
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Steps for developing the case for an adherence strategy
BUSINESS CASE Including summary of key opportunity, alignment needs, implementation needs, recommended
skeleton solution overview (outcomes, measurement, budget, timings, CSFs)
Adherence issues and opportunities
identified?
The organisation is aligned to address
these issues?
Solution framework and implementation
considerations developed?
Investment defined, and potential impact
assessed?
1 2 3 4
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Investment needs to be better distributed between acquisition & retention
Oliver Wyman Report: A Prescription for Change: The New Go-to-Market Model for the Pharmaceutical Industry 2009.
Effective AdherenceSolutionsMarketing budget spend
89% v’s 10% v’s 1%On patient Payor On patientacquisition marketing retention
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Adherence strategies can deliver for ALL stakeholders
PatientsDo more, feel better, live
longer
Personalised solutions
PharmaImproved sales from existing
patients
Improved market access
Competitor differentiation
HealthcareImproved outcomes
Reduced wastage
Lower healthcare utilisation