© Matrix45, 2005. All rights reserved. enhancing one-on-one physician communications through the use of evidence-based e 2 marketing ivo

© Matrix45, 2005. All rights reserved.www.matrix45.com

enhancing enhancing one-on-oneone-on-one physicianphysician communicationscommunications through the use of through the use of evidence-basedevidence-based ee22marketingmarketing

ivo abrahamivo abraham

[email protected]@matrix45.com

center for business intelligencecenter for business intelligence““emarketing for the pharmaceutical industry”emarketing for the pharmaceutical industry”philadelphia, 17 march 2005philadelphia, 17 march 2005

MATRIX45620 Frays Ridge RoadEarlysville, VA 22936 – USA+1.434.978.1045www.matrix45.com

Offices in US and Europe

2 © Matrix45, 2005. All rights reserved.www.matrix45.com

overviewoverview

concept of econcept of e22-marketing-marketing

penetration and adoption of best penetration and adoption of best practice guidelinespractice guidelines

knowledge knowledge clinical behavior change? clinical behavior change? macro vs. micro evidence “micro-trialing”


overviewoverview

case studycase studymanagement of mild asthma in primary care

» drivers» analysis» solution

benefitsbenefits


ee22-marketing-marketingdefining the conceptdefining the concept

eelectronic lectronic andand eevidence-basedvidence-based capitalizing on the power of the internet harnessing the value of evidence-bases

for clinical practice

stimulating stimulating clinician behavior changeclinician behavior change in complex clinical areas through in complex clinical areas through data-driven, value-added support data-driven, value-added support servicesservices … and to so … and to so improveimprove sales, sales, patient outcomes, clinician patient outcomes, clinician competence, and economics of care.competence, and economics of care.


ee22-marketing-marketingprocessprocess

building and maintaining physicians’ building and maintaining physicians’ clinical confidence in product-centric clinical confidence in product-centric treatment solutionstreatment solutions product » therapy » treatment solution knowledge-based relationship

pharma ~ physician “tryout trials” + outcomes-focused

feedback reinforcement + renewal


ee22-marketing-marketingvalue propositionvalue proposition

clinical confidence

clinical behavior change

↑ product adoption

↑ market position

↑ sales ripple effects

treatment solutions, loyalty, cross-over, …


evidence-based practiceevidence-based practiceideal vs. real-worldideal vs. real-world

meta-analyses▼

randomizedcontrolled trials

▼“quasi-experimental”

studies▼

cohort / observationalstudies

▼case-control studies

▼cross-sectional

studies▼

clinical cases▼

expert opinion

RCTsquasi-

experimental

meta-analyses

case-control

cohort-observational

cross-sectional clinical

cases

(expert)opinion


two approaches two approaches (Eddy, Health Affairs 2005)(Eddy, Health Affairs 2005)

evidence-based guidelines evidence-based individual decision-

making

(re-)definition(re-)definitiona set of principles and methods intended to ensure that to the greatest extent possible, medical decisions, guidelines, and other types of policies are based on and consistent with good evidence of effectiveness and benefit (Eddy, Health Aff 2005)

evidence-based practiceevidence-based practicedefining the concept(sdefining the concept(s))


>1000 guidelines created annually>1000 guidelines created annually(Jackson & Feder, BMJ, 1998; Rosser et al., J Fam Practice, 2001) (Jackson & Feder, BMJ, 1998; Rosser et al., J Fam Practice, 2001)

few guidelines lead to consistent few guidelines lead to consistent changes in provider behavior changes in provider behavior (Cabana et al., JAMA 1999; Grol, Med Care, 2002; Timmermans & Mauck, Health Aff (Cabana et al., JAMA 1999; Grol, Med Care, 2002; Timmermans & Mauck, Health Aff 2005)2005)

asthma(Goodman et al., Pediatrics 1999; Johnson et al., Pediatrics 2000; Crim, Chest, 2000; Lagerlof et al., Eur Resp J, 2000)

beyond asthma: mean adherence rate of 54.5% (Burstin et al., Am J Med, 1999) – probability ~ 50% (Med Care, 1994)

evidence-based practiceevidence-based practiceknowledge knowledge clinical behavior change? clinical behavior change?


asthma: the “ideal” disease asthma: the “ideal” disease (Timmermans & (Timmermans &

Mauck, Health Aff 2005)Mauck, Health Aff 2005)

serious public health concern » most common chronic illness of early

childhood» rising incidence» USA: 5000 deaths/year, 470000 hospital

admissions/year, 13.7 ambulatory care visits/patient

ample guidelines available and among the best known of pediatric guidelines (Flores et al., Pediatrics, 2000)



asthma: the realityasthma: the reality adoption of guidelines

» “mixed and disappointing” (Timmermans & Mauck, Health Aff, 2005; Stoloff, Am J Managed Care, 2000)

knowledge about versus following guidelines

» US pediatricians: 88% familiar yet 35% followed guidelines (Flores et al, Pediatrics, 2000)

» hospital-wide implementation: 68% adherence (Smeele et al, Qual in Health Care, 1999)



evidence-based practiceevidence-based practicemore “real world” examplesmore “real world” examples

hypertensionhypertension “real world” practice ≠ trial evidence

and best practice guidelines (JNC7, ESC, …)

» diagnosis (diabetes / nondiabetes)» targets» treatment options and adjustments» risk factors for cardiovascular events» patient outcomes


evidence-based practiceevidence-based practicemore “real world” examplesmore “real world” examples

anemia management in dialysis anemia management in dialysis patientspatients “real world” practice ≠ trial evidence,

observational studies findings, and best practice guidelines

severe sepsis / septic shock (Xigris®)severe sepsis / septic shock (Xigris®) accelerated approval » commercial failure uncertain area ~ low clinician confidence evidence-base of 1 with hypothesized MOA unlinking product and clinical process


evidence-based practiceevidence-based practicethe blind adoption problemthe blind adoption problem

randomized controlled trials as the randomized controlled trials as the only parameter of evidenceonly parameter of evidence

““if the wise (wo)men say so, i shall do if the wise (wo)men say so, i shall do so”so”

de-skilling of clinicians – cookbook carede-skilling of clinicians – cookbook care

misunderstanding ethics, feasibility, misunderstanding ethics, feasibility, and knowledge development issuesand knowledge development issues


macro-evidencemacro-evidence evidence from

studies + meta-analyses

formal learning

micro-evidencemicro-evidence evidence from

one's own clinical experience and experimentation

application in one’s own practice

evidence-based practiceevidence-based practicemacro- vs. micro-evidencemacro- vs. micro-evidence


macro-evidencemacro-evidence “seeing the

larger picture” – “many-other-patients“ – “what-patients-should-be-like”

mega-knowledge

micro-evidencemicro-evidence “seeing with

one's own eyes" - the "my-patients" picture

micro-trialing

evidence-based practiceevidence-based practicemacro- vs. micro-evidencemacro- vs. micro-evidence


micro-trialingmicro-trialing knowledge knowledge » confidence » » confidence » behaviorbehavior

anecdoteanecdote “rep has been here several times now” “i’m reading and hearing more about

‘that product’, maybe I should try it out” “let me try it on my next ten patients and

we’ll see”

physician focus on physician focus on systematically systematically tryingtrying the product but the product but ununsystematically examining systematically examining patient patient outcomesoutcomes


micro-trialingmicro-trialing knowledge knowledge » confidence » » confidence » behaviorbehavior

supporting physicians in supporting physicians in exploring and adopting new treatments changing personal practices and

standards of care going against “established” practices

(from ‘known’ to ‘innovation’) expanding if not changing their “clinical

comfort zone”


case-studycase-study

backgroundbackground asthma: ↑ incidence = ↑ global market treatment options for asthma are driven by

severity and persistence» inhaled corticosteroids $ 2.76 B» beta-2 antagonists $ 3.74 B» leukotriene anatgonists $ 2.12 B» combinations $ 3.10 B

$ 11.7B2003 global sales; Morgan Stanley, 2004



background: market share of LTRA in background: market share of LTRA in USA vs. Europe/Japan by patient classUSA vs. Europe/Japan by patient class

LTRA market leader in USA, ICS in ROW

number of market number of market number of market number of marketpatients share patients share patients share patients share

severe persistent patients 1,118,000 55.0% 1,312,000 55.0% 1,986,000 20.0% 2,129,000 28.5%moderate persistent patients 3,129,000 40.0% 3,681,000 51.0% 5,712,000 17.5% 5,987,000 23.0%mild persistent patients 1,841,000 29.0% 2,270,000 31.0% 3,611,000 12.0% 4,258,000 12.0%mild intermittent patients 597,000 12.5% 760,000 14.0% 1,024,000 10.0% 1,268,000 10.0%

Morgan Stanley, 2004

USA Europe & Japan2003 2010 2003 2010



background: evidence-basebackground: evidence-base best practice guidelines in usa & europe

» step-up step-down approach» inhaled corticosteroids (ICS) most effective

anti-inflammatory agent to control asthma» LTRA class recommended as “may be

considered” for mild persistent asthma as place in therapy is not fully established

» importance of steroid-sparing therapy



background: evidence-base background: evidence-base (cont’d)(cont’d)

best practice guidelines: canada» ICS as first line therapy» LTRA recommended as alternative therapy» deep dissemination and penetration

role of biopharma companies with vested interests

blind adoption trend in primary care

evidence related to LTRA continues to accumulate


analysisanalysis

innovation

best practiceguidelines:geographicalboundaries in a global medical community

disseminating toa nonspecialist,(relatively)research-naïve physicianpopulation

positioning

at the interface of marketing andmedical affairs

conventional salesstrategies and tactics:• necessary but not sufficient• change pharma- to physician relationship

relationship

informationtransfer knowledge-based

value-added

in line withphysician values


analysisanalysis

physicians

getting out of“clinical comfortzone”

gain and maintainconfidence inproduct & therapy:• knowledge• experience

outcomes and risk managementframe-work

market

investment market strength

evidence-based(e)Learning

postmarketingstudy fatigue:• perceived return• beyond just money• value-added services

e2-marketing

electronic andevidence-based

growing demand• specialty care• primary care

competitiveadvantage

beyond e-gimmicks



objectivesobjectives create an evidence-based platform for

effecting clinical behavior change in primary care physicians in the management of asthma

increase experience base of clinicians in managing asthma with through micro-trialing

» systematic data framework» feedback to examine outcomes in their patients» technology-enabled



objectives objectives (cont’d)(cont’d)

improve and maintain physician confidence in target therapy

increase persistent product adoption strengthen market position increase market share and sales


RiskScreening

RiskManagement

ClinicalSupport

Clinical Outcomes@ Patient Level

Clinical Outcomes@ Practice Level

Evidence-BasedBenchmarks

case-studycase-study framework framework


case-studycase-study process process

large cohortparticipatingphysicians /

centers

retrospectivechart audit

conversiondecision per

physicianbest judgment

newpatients

startdecision per

physicianbest judgment

longitudinaldata

collectionon Rx and

patientoutcomes

datatransmission

feedbackreports to

physicians:

patient Xmy patientsall patients

benchmarks


case-studycase-study flowchart flowchart

case-studycase-study flowchart flowchart

analyticaldatabase

entry of patient

dataMD

web-basede-reports

analysespatient X

my patientsmy pts vs. all pts

my pts vs. benchmarks

1:1pharma tophysician

plan-driven and ad hoc analyses

on aggregate sample

dissemination

pharmadatabases

pharma


ee22-marketing-marketingbenefits to physiciansbenefits to physicians

researchparticipation

new model ofresearch participation

micro-trialing

contribution to larger study

bridging the chasmefficacy effectiveness

safety monitoring

new relationshipwith pharma

one-on-oneknowledge-based

on exchange basis:data value-addedservices in return

in line with values

experience, confidence,clinician decision-making,patient outcomes


ee22-marketing-marketingbenefits to pharmabenefits to pharma

integrated approach

physician-focused support

accumulating real-worldeffectiveness data

databases on practice patterns and outcomes

safety monitoring

conventional scientificproductivity is enhanced

one-on-one physicianrelationship

knowledge exchange information transfer

aligned with current thinkingin medicine

overcomes limitations of andreframes evidence-based practice

interface with (e-)detailing


ee22-marketing-marketingbenefits to pharmabenefits to pharma

efficiency

large coverage atminimal incremental cost

coordination marketing ~medical affairs

pays for itself throughongoing product sales andripple effect

effectiveness

data on practice patterns andoutcomes support strategy

extended pharmaco-vigilance

market position: what is theeffect on sales?


global expansion of survey (1998-2002) within and across indications ~ worldwide sales growth from $1.5 billion (1998) to $4.2 billion (2002)

-5

0

5

10

15

20

25

30

35

40

implementation of 6-month

longitudinal study

state-of-the-art symposium

ee22-marketing-marketingimpact on salesimpact on sales

% change in sales of blockbuster in western europe


ee22-marketing-marketingrevisited & summarizedrevisited & summarized

e-marketing e-marketing e e22-marketing-marketing electronic and evidence-based to effect clinical behavior change

product adoption market position

sales ripple effects



challenges of adopting best practice challenges of adopting best practice guidelinesguidelines micro-evidence micro-trialing

model and model and serviceservice of evidence-based of evidence-based supportsupport asthma extendable to other diseases and drugs



the value of value-added services the value of value-added services

benefitsbenefits physicians biopharmaceutical companies

impact on patient care?impact on patient care?

To download this presentation, please go to the News section at www.matrix45.com

Documents

© Matrix45, 2005. All rights reserved. enhancing one-on-one physician communications through the use of evidence-based e 2 marketing ivo