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Vol. 18 No. 1
Spring 2016
This Issue:
Letter from the President . . . . . . 1
Classification Corner . . . . . . . . . . 2
2016 AGM . . . . . . . . . . . . . . . . . . 4
Industry Forum
The Art of Storytelling in Pharma
Market Research . . . . . . . . . . . . . . . . 4
Re-imagining the Role of Simulation
in Physician Research . . . . . . . . . . . . 8
To Define the Value of Cancer Care,
Prioritize the Patient . . . . . . . . . . . . . 11
A Multi-Faceted Approach to Patient
Adherence . . . . . . . . . . . . . . . . . . . . 13
Letter from the President
Dear PBIRG Colleagues,
Building on the leadership that Daryl Bogard showed as our 2015 President, 2016 continues to be
a year of dynamic change and growth for PBIRG. Our evolution reflects that we not only have
listened to the needs of our membership, but to the needs of the healthcare industry as a whole.
I have enjoyed being a part of PBIRG and take a lot of pride in the quality of each of the workshops
we have put on so far this year. Based on our successes and the feedback we have received, you
can expect the following to continue (I hope you hold us to this):
• Learnings from inside and outside pharma about the aging / complex patient
• Shortened and focused presentations both in workshops and at the
Annual General Meeting (AGM)
• Future AGM sessions will not be “destinations”, making them easier to attend
The extraordinary efforts of our co-chairs will provide what I expect will be one of the most
dynamic meetings of 2016. Justin Edge (GfK) and Margie Stelwagon (Ironwood) bring not only
extensive experience and innovative personalities, but a willingness to push PBIRG outside of its
comfort zone. We are better for it and I thank them for their efforts.
The reality we worked to stay ahead of is as an organization we recognize that if we stand alone, we
will fail. With that in mind, this year we celebrated our first joint PBIRG and PMRG networking
the supported the Ronald McDonald House. This event included a joint executive committee
meeting to discuss industry trends and potential approaches to address those trends (perhaps
collaboratively). This event would have not happened if it were not for the persistent efforts of
Sherry Fox, Paul Gorman, Dean Kameros and the excellent collaboration from Diana Pohle, Carol
Reilly and Stephanie Reynders.
While I appreciate all of the support I have received from Merck and fellow industry members, it
is the affiliate members and Carol that I would especially like to thank for both their support and
intellectual generosity.
And finally, Carol Reilly has spent 20 years as the soul of PBIRG. Her patience, work ethic and
support cannot be over stated. I hope you will join us in Boca Raton as it will be a special event.
Looking forward to seeing you there,
Kai Bode
PBIRG President
Serving the industry for over 50 years
May 15, 16 & 17, 2016 PBIRG 2016 Annual General Meeting Boca Raton Resort & Club, Boca Raton, Florida
September 2016PBIRG Fall Education Workshop Series & Industry Networking Reception Bridgewater Marriott, Bridgewater, NJ
November 20162016 PBIRG Biotech Workshops & Industry Networking Reception (TBD)
Upcoming PBIRG Meetings and Events
President Kai Bode, Merck & Co., Inc. Phone: 267/305-7833 [email protected]
Past President Daryl Bogard, Allergan Phone: 714/246-5518 [email protected]
Vice President Maura Snyder, Janssen Pharmaceuticals President-Elect Phone: 908/218-6322 [email protected]
Treasurer Dr. James Parrish, Pfizer, Inc. Phone: 484/865.2577 [email protected]
VP Program Brian Cain, Ironwood Pharmaceuticals Development & Phone: 617/374-5145 Education [email protected]
Vice President Anthony Recalde, Merck & Co., Inc. Business Research Phone: 267/305-1252 [email protected]
Vice President Margie Stelwagon, Ironwood Pharmaceuticals Primary Research Phone: 617/768.2611 [email protected]
BioPharma Kelly Marino, Fulcrum Research Group Initiative Phone: 781/209.5327 [email protected]
Secondary Data Eze K. Abosi, Decision Resources Group Source Issues Phone: 973/352.8759, Committee [email protected]
Classification Anthony Palkovic, Chair, Pfizer, Inc. Committee Phone: 212/733-2116 [email protected]
Registrations Jeff Chase (Chair), HRA Research New Members Phone: 973/240.1216 [email protected]
Jim Goldenberg, Double Helix Discovery Phone: 267/289.0310 [email protected]
Jeff Histand, Reckner Healthcare Phone: 267/956.5072 [email protected]
Technology Anthony Recalde, Merck & Co., Inc. Committee Phone: 267/305-1252 [email protected]
Primary Research Jim Goldenberg, Double Helix Discovery Committee Phone: 267/289.0310 [email protected]
James Heasley II, PhD, Evolution Consulting & Research Phone: 267/405.8021 [email protected]
Professional Heather Randolph, Eli Lilly & Co. Training & Phone: 317/605-7684 Development [email protected]
2016 Annual General Margie Stelwagon, Ironwood Pharmaceuticals Meeting Co-Chairs Phone: 617/768.2611 [email protected]
Justin Edge, GfK Phone: 312/416-3676 [email protected]
Poster Showcase Trevor Jenkins, Daiichi Sankyo Coordinator Phone: 973/944-2496 [email protected]
Alternate Dan O’Brien, IMS Health Committee Phone: 484/567.6371 Member [email protected]
Executive Director Carol E. Reilly Phone: 215/855-5255 [email protected]
One of the primary benefits to the industry is that participation in PBIRG allows individuals from the pharmaceutical industry to actively represent the interests of their company on all industry-related issues. It also provides the opportunity to develop leadership skills, enhance industry knowledge, and gain exposure within the pharmaceutical arena. PBIRG Executive Committee members have the opportunity to develop a broad, overall perspective of the dy-namics/inner-workings of the pharmaceutical business by interacting with other peers and leaders within the industry. If you are interested in joining the PBIRG Executive Committee please contact [email protected]. © 2016 PBIRG. All rights reserved.
PBIRG Perspective design and layout by Graphics House © 2016 www.gh-service.com
Classification Harmonization Meeting: World Health Organization – February 2016
The annual WHO/EphMRA/PBIRG Harmonization meeting was held in February 2016 in Oslo at the WHO Centre. There were attendees from the EphMRA/PBIRG Classification Committee and representatives for the WHO. Once again, this was a very productive session to ensure understanding and work towards harmonization of the two classification systems.
Many topics were reviewed to further harmonize the two systems where this is feasible. Because the purposes and basis of the two systems are different, full harmonization is not possible. The Committee produces a comparison document outlining the relationship between the classes in the two systems and this has proved to be an extremely useful guide. The document has been updated with the 2016 changes and is available on the PBIRG website.
April 2016 Meeting
The Committee met in April in Rome on the MSD campus, hosted by Marilena Lauriola.
Good progress was made on the classification development proposals that were likely to be voted on by the EphMRA/PBIRG membership in May 2016. These proposals include developments in: inflammatory bowel disorders, drugs for pulmonary arterial hypertension, new classes for antineoplastics, and drugs for multiple sclerosis.
Many other topics were discussed including the classification of several new substances and combinations, as well as clarification of certain classification rules.
The summary of current projects and decisions made as a result of the Committee meetings are available to PBIRG members via the PBIRG website.
Classification Developments – thank you!
Many thanks to all the companies that have provided input when requested by the Committee as it is part of our process for developing new classes. It is vital that we get your feedback in order to make the changes relevant and useful.
In addition, thank you for participating in the voting process this year for the new classes for 2017 – again; you are key in ensuring the classification system lives!
Key Other Meetings in 2016
• June meeting: week beginning 22nd June in Frankfurt
• September – proposed during week of 19th September
• December – proposed during week ending 2nd December
C L A S S I F I C A T I O NC O M M I T T E E
Anthony Palkovic
PBIRG Perspective
3For additional information or to register online, visit www.pbirg.com
Make plans to join us in New Orleans — May 17, 18, 19 and 20!
TUESDAY – MAY 17Session Speaker
Eric Trépanier, PharmD,
Group Vice President Marketing Science,
Medscape | WebMD
MONDAY – MAY 16Keynote Speaker
Erich Joachimsthaler,
Consultant on Marketing and Brand Strategy
WORKSHOP 1How Physicians Use Emotion When Making Prescribing Decisions
WORKSHOP 2Let’s do the Charlson! Forecasting Co-morbidities Across Countries and Age Groups
WORKSHOP 3The Aging Consumer: How Multi-Category Involvement is Changing Marketing
WORKSHOP 4Making a Brand Matter: An Integrated Research Program that Revealed How to Connect a Brand with Physician’s Motivations
WORKSHOP 5Assessing Adherence and Usage Behavior to Identify and Project Product Usage among Chronically Ill Patients with Idiosyncratic Treatment Plans
WORKSHOP 6Bridging the Gap Between Identifying and Designing for Needs of the Aging Population
WORKSHOP 7Innovative Approaches Addressing the Complex Patient – A Non-Pharma View
WORKSHOP 8How Companies Worldwide are Breaking New Ground in Understanding Rare Diseases and How They Find Undiagnosed Patients with These Rare Conditions
WORKSHOP 9Adopting a Patient-Center Approach to Oncology Marketing
WORKSHOP 10Creative Problem Solving Part 1: The Curse of Knowledge
WORKSHOP 11Get More Out of Claims Data By Using the EMR as Teacher
WORKSHOP 12Hearing the Patient: Using In-Office Data to Uncover Patient Needs
WORKSHOP 13Creative Problem Solving Part 2: Are You Solving the Wrong Problem?
WORKSHOP 14
Smart Practices for Maximizing Value from Patient-Record Studies
WORKSHOP 15
Identifying Health Values to Engage Consumers Across Generations
WORKSHOP 16
Countering Complexity with Agility
WORKSHOP 17
Simulating the Impact of the Aging Population on Disease Epidemiology and Therapy Dynamics
WORKSHOP 18
Winners & Losers: The Impact of Early Palliative Care on Disease-Directed Therapies
WORKSHOP 19 & 20
voted best 2 Monday Workshops repeated
WORKSHOP 21
Information, Motivation, and Skills for Success: Onboarding New Patients on Therapy
New Product Forecasts: Challenges and SolutionsPresented by Stephen Murdock, Principal CharlesView Solutions, LLC
Exploring Doctors’ Irrational ChoicesPresented by Soumya Roy, CEO of US Health Hall and Partners
SUNDAY
PRE-CONFERENCE
CO-MODERATOR
Mary E. Dominiecki, PhD
Senior Research Director, The Planning Shop International
CO-MODERATOR
Stephen Godwin
Senior Research Director, The Planning Shop International
PANELIST
Joseph G. Ouslander, MD Senior Associate Dean and Professor, Geriatric Programs, Charles E. Schmidt College of Medicine
PANELIST
Donald Bolser, PhD Professor and Associate Chair, Department of Physiological Sciences, College of Veterinary Medicine, University of Florida
PANELIST
Neal E. Ready, MD, PhD Associate Professor, Medicine Duke University School of Medicine
TUESDAY MORNING PANEL DISCUSSION
BETTER DRUG DEVELOPMENT PLANNING = BETTER MEDICINES How asking better questions early on in the drug development process may
lead to more successful drug launches
TUESDAY AFTERNOON PANEL DISCUSSION
THE EVOLUTION OF BECOMING MORE INDIVIDUAL CENTRIC See our website for further information
Spring 2016
4
A visual story is even more powerful.
The Power of a Good StoryA good story has the power
to captivate an audience and leave a lasting impression.
INDUSTRY FORUM
Industry Forum submissions are solicited from both PBIRG Industry and Affiliate members, are editorial in nature, and do not necessarily reflect the opinions of PBIRG. Member submissions should be sent to PBIRG.
The Art of Storytelling in Pharma Market Research By Julie Denny, Marketing Director
Research Partnership
Firstly, we are suffering
from information
overload. And let’s face it,
the complexity of information,
data and statistics in a typical
market research report are not easy to
remember. Our brains are naturally wired to
respond to a narrative, which helps us make
sense of the facts. By building a story
around the information, our audience
finds it easier to understand what the
research is trying to tell them, without
wading through the entire report.
Secondly, in pharma we have a lot
of stakeholders to communicate with.
The insights from the market research might need to be
shared with regional offices, the marketing team, sales reps, product managers, senior
management, research and development, the list goes on. All these people are based in different sites, perhaps in
different locations around the world. Technology has afforded us the ability to share information much more easily. But the
information has to be digestible and in a format which can be easily understood. Applying the principles of storytelling
in our deliverables allows recipients to engage with the insights and recommendations far more readily. It elevates the
outputs from market research report into a strategic tool for decision-making.
And finally we have to respond to the rapid pace of change affecting not just pharma but all of business. Our stakeholders
need to know now, so that they can take action now. Storytelling the market research insights gives our stakeholders just
Storytelling – it’s the (not so) new buzzword in pharma market
research. But why are we paying more attention to it now as a way of
enhancing our service offering? There are probably a number of factors
driving its adoption amongst research agencies, some specific to the
pharmaceutical industry and some common to all businesses.
PBIRG Perspective
5
Today’s market researchers have to bring the data to life and
deliver findings in an engaging way.
90%of information is takenin by the brain visually
65%of people arevisual learners
the information they need. The supporting evidence is still there
if they need it, but they get the picture without it.
The principles of storytelling
Research Partnership hosted a very well-
attended webinar on the subject recently. We
explained that stories are built using 4 principal
ingredients:
Characters, Actions, Time and Settings (CATS)We all know the story of Cinderella, who is
enslaved by her stepmother and two ugly sisters
until she meets the handsome Prince, is given magic to
help her get to the Ball and is finally found by the Prince with
the help of the glass slipper. This story tells who you did what,
when and where to make the essential details easy to remember. And
it’s very visual, which helps the reader create a mental picture of what is
happening. To build a good story, we first start with CATS.
We also talked about the fact that a story lies on three interconnected planes. What
happens in one has an effect on the others to a greater or lesser degree.
There is the small story of a personal or individual experience (a patient for example), which is connected
to a bigger story of a group or organisation (a healthcare company) which in turn are both connected to an even
bigger national, social, political or world story (so a change in government for example could impact both the patient and the
company).
It is easier for an audience to understand, appreciate or be involved in the biggest story if they know the small personal or
individual story first. There is often the need to say more than we have time for or that our audience can absorb and be motivated
by. Therefore short detailed stories that carefully describe one
aspect of a bigger picture are more easily shared and accepted.
Finding the storySo, how do we use these principles to find the story in our market
research?
We believe that there are 5 key steps to finding and building
your story. Firstly, you must identify the central premise. In
traditional storytelling this might be the power of love, or
good versus evil. In pharma, we may be looking for
where opportunity lies for a brand, or searching
for unknown information to “fill the
gaps”, or we may be exploring
and adding to existing
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III
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VIII
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XXI XII
Stories have a unique ability to bind data with emotion, context,
and most importantly, meaning.
knowledge
such as a buying process,
or patient journey.
You also need a clear narrative, with a beginning, middle and an end.
In market research, we need to address the business problem,
highlight the key insights from the research and then
provide strategic recommendations for how to
improve the business.
For example, if the key
business problem
is, “What is
the
best
positioning for the
brand?” research might show
that duration of efficacy is considered
more important than fast onset of action so positioning should be focused on long term benefits and play the tortoise in the
race, rather than the hare.
There also needs to be a central character, or protagonist, whose perspective the story is based on. This doesn’t necessarily
have to be the customer. Your story could be taken from the perspective of the patient, a caregiver, the sales rep, a product
or device. The central character could even be who or whatever is causing the conflict or business problem. Building stories
from a new perspective can introduce fresh insights that the client hasn’t considered before.
The story also needs tension or conflict. For example the business question could be around product opportunity, and the
conflict could be barriers to using a product. For example the lack of diagnostic resources could result in fewer patients
being diagnosed, which means the product will be used less.
Finally, a story arc is required to show how the situation could be changed over time, to reveal how we can move forward
from the problem towards a resolution with recommendations for how to market the brand.
PBIRG Perspective
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A good story will help key stakeholders
to understand the insights...
...keeping them connected
to the brand.
Using data visualisation to share your storyOf course, as market researchers our aim is to find the answers addressed
in the business question. And we do this rigorously and thoughtfully,
using the best methodological approaches and analytical tools.
But the stakeholders of our research don’t have to know
how we got to the answer, they just need to know
what the research means and what to do
about it. Consequently, our outputs
For more information on our storytelling initiative, contact us:
researchpartnership.com
have resourced our own in-house graphic design
capabilities, which are allowing us to create much more visual
outputs alongside the traditional market research report. We create short animated videos, infographics,
films, posters and other data visualisation outputs to help disseminate the insights. And for quantitative studies we create
interactive dashboards to allow cross-country or cross-functional teams to access and manipulate the data in the way that they
need.
Storytelling is a hot topic right now because market researchers recognise they need to be able to communicate and share the
key insights with a broader set of stakeholders in a way that is engaging and relevant. And data visualisation tools, used well,
are helping to do just that. We believe that storytelling is an art which all market researchers will need to hone in order to truly
elevate the value of their professional services. A good story will help pharma build a firm understanding of the insights and if
applied to marketing strategy, help build an emotional connection to the brand.
need to deliver on
that need. Many research agencies
have sought to address this requirement
by reviewing the way in which they present their
findings. Reports are formatted to give the insights and
recommendations right up front, with the supporting evidence
following after. But technology is allowing us to go one
step further. We can now create more visual outputs which
engage audiences more fully in the research findings. Visual
stories have been found to be even more effective at helping
us retain and use information. At Research Partnership, we
Spring 2016
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INDUSTRY FORUM
It is worthwhile exploring why we intuitively view quantitative and qualitative simulations as being so different. Certainly their implementation relies on very different skillsets and they are typically employed to address very different research issues. We would argue, however, that the most important distinguishing characteristic of simulations at the extremes is the relationship between the simulation and the human actor whose behavior determines its critical outputs. In the case of the mock sales call, for example, a living, breathing physician engages in role play with a similarly living, breathing sales representative. The value of the research derives from the observation of the behavior of the physician within the simulation. In contrast, a systems dynamics
model will rely on estimates of physician behavior—often derived
from surveys. The physician may contribute to the simulation, but
neither exists within it, nor interacts with it directly; he is exogenous
to the simulation.
Now imagine for a moment what might happen if we collapsed
our quantitative-qualitative simulation axis and brought the living,
breathing physician from the qualitative world into a dynamic,
quantitative, data driven market simulation. What would such a
simulation look like, and what would be its application? Could
such a simulation offer a better solution to some of our most
vexing market research challenges?
Re-imagining the Role of Simulation in Physician ResearchBy Hilary Fischer, Chief Revenue and Strategy Officer,
SHC Universal and Greg Chu, Principal, KMK Consulting
The spectrum of simulation methods
used in healthcare market research
and analytics can be arranged
along a single axis that runs from
“quantitative” to “qualitative”. At
the quantitative end of the axis we
find sophisticated market models:
spreadsheets running Monte Carlo
simulations or systems dynamics
models calculating stocks and flows
of patients or scripts. At the other
end are the qualitative simulations,
such as mock sales calls or mock
clinics in which physicians are asked
to examine actors pretending to
suffer from a particular ailment.
While most researchers would
likely agree that both ends of this
hypothetical axis describe types of
simulations, they would undoubtedly
also assert that these simulations are
very different.
PBIRG Perspective
9
Placing the Physician in Task
The notion of plugging a respondent into a simulation likely conjures up images from The Matrix, or, more realistically, some sort of immersive experience created through VR headsets. Market research with physicians may someday routinely leverage virtual reality technology, but the fundamental concept of placing a physician within a simulation can be achieved today through far more modest means. In fact, we already attempt to do this through various methodologies, including questionnaires. When we ask a physician how they would treat their next 100 patients presenting with a certain set of symptoms, we are, in fact, setting up a very crude type of simulation. The problem, of course, is that the chasm between the questionnaire and any evocation of reality is huge. There is no real interactivity and no real consequence to the physician’s response. As a result, questionnaires often fail to engage physicians—particularly when they pursue complex topics like treatment algorithms for multiple patient types over multiple lines of therapy; the data gathering task here is at best tedious, and at worst, mind-numbing.
With these thoughts in mind, KMK Consulting set out to develop and experiment with a computer-based simulation built around the management of virtual patients. The goal was two-fold: first, to determine whether valuable market research data could be generated from a simulation in which physicians are tasked with the diagnosis and treatment of patients and, second, if such a simulation could improve physician engagement with market research surveys. Given the importance of the latter issue to the industry, we sought out SHC Universal to help us review our experience across a number of therapeutic areas. What follows is our joint perspective on what we have learned about the potential of simulation in physician market research.
Five Key Learnings
1) Efficient Generation of “Big Data” on Treatment Practice
Our experience suggests that simulation offers a very efficient way to generate longitudinal patient records through the linkage of virtual patient profiles with the actions taken by physicians in managing these patients over multiple visits. The result is a surprisingly rich dataset that can provide insight into both treatment algorithms and the drivers of physician decision-making. While the data flowing from patient simulations appear similar to that acquired through chart audits, computer-based simulation adds one additional analytic dimension worthy of note. Since every action taken by the physician within the simulation can be recorded and time-stamped, the physician interaction with the simulation itself can be analyzed alongside his decision outputs. This opens up new avenues for exploring the relative importance to physician decision-making of specific aspects of the patient’s presentation and history, lab tests or other characteristics, as revealed through the order and frequency of accessing this information and through the length of time spent viewing it.
2) Greater Respondent Engagement
Across our various tests of simulation, we have found a strong preference among physicians for the simulation platform over the on-line survey formats they are used to; respondents report that
the simulation is more interesting than traditional surveys and is easy to use. We attribute this positive response first and foremost to the alignment of the simulation task to their thought processes. As one psychiatrist said, “This works for our brain because this is how we think… we think, we assess, we treat, we reassess, we treat, we see if our diagnosis was right, we reassess, we treat and that’s how it works.” A second insight emerged from response to a key aspect of the simulation design—the return of the virtual patient over multiple visits with new presentations determined by the physician’s prior treatment decisions. This aspect of the simulation piqued respondents’ interest and curiosity. As one ENT put it, “You want to see what happens after two weeks. What’s better than that? How many people are like ‘Wow, another question! No. Let’s see what I did!” The lesson we draw from this is that realism and interactivity delivered through simulation can boost physician engagement in market research tasks.
3) Agile Experimentation
Rapid prototyping and A/B testing have become hallmarks of agile design and experimentation in the digital world. Some of these ideas have permeated the somewhat insular realm of physician market research. Unfortunately, many market research issues that could be informed by rapid prototyping and experimentation confront a range of obstacles such as cost and timing that prevent their widespread use. In our work, we have discovered that a simulation platform built around virtual patients can serve as a fast, flexible and cost-effective vehicle for experimentation. “Cloned” patients who are almost identical in every way except one can be inserted into the simulation to assess the impact of that one variable on treatment decisions. An environmental change, such as the imposition of a prior authorization on product x, can be introduced to assess the impact of a PA on prescribing. New products can be introduced into the simulation to estimate penetration into targeted patient segments. As we explore the many ways in which patient profiles and environmental scenarios can be manipulated within simulation, we see a clear path to making the benefits of experimentation more readily available.
4) Unlocking the Potential of Gamification
Many researchers argue that the impact of gamification in physician research has fallen far short of the expectations held by its most fervent proponents. If true, the disappointment may stem from the fact that a survey, no matter how artfully gamified, is still a survey. In contrast, we have learned that simulations, even without deliberate attempts at gamification, intrinsically possess many of the engaging aspects of games. Among these are verisimilitude to a task of interest, problem solving and goal achievement. Games and simulation are, in fact, widely recognized as sharing many characteristics—so much so that it is sometime difficult to tell them apart. Our experimentation with simulation confirms this perspective and leads us to the conclusion that the future of gamification in physician market research lies in the development of simulations that incorporate game elements customized to address specific market research needs.
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5) A Compliance Friendly Platform
Issues of compliance may not be glamorous, but they are never far from the minds of market researchers. Therefore, we would be remiss in not mentioning a significant compliance related benefit offered by simulation. Until the FDA demands that virtual side effects be reported, there are no AE reporting responsibilities associated with virtual patients. Similarly, virtual patients have no personally identifiable information to protect. Finally, since physicians interact with the simulation only through a touchscreen, touchpad or mouse, and are offered no opportunity to introduce new information via a keyboard, it is impossible for the simulation to capture any reference to real world adverse events.
Conclusion
Plugging a flesh and blood physician into an intuitive and engaging simulation built around virtual patients offers many intriguing opportunities for advancing the state of the art in physician research. We have already tested and confirmed some of these opportunities. Others remain to be explored and validated. But we are convinced that the broader use of physician-centric simulations can address many of the research challenges we confront today: decreasing respondent engagement, understanding complex treatment algorithms and expanding the use of experimentation.
Register Today
PBIRG Perspective
11
INDUSTRY FORUM
To Define the Value of Cancer Care, Prioritize the PatientBy Soumya Roy, PhD, and Kinga Zapert, PhD,
Hall & Partners | Health
Oncologists are invigorated by the
promise of emerging cancer care
innovations, like immunotherapies.
But today, financial concerns color
every treatment decision—as the
industry seeks urgently for “value.”
Insurance payers, the pharmaceutical
industry, and oncologists themselves
are all asking one another good
questions as they compare and
champion interventions. But to
speed the journey of tomorrow’s
top treatments into today’s
practices, any investigation into the
value of innovation must elevate
the perspective of the ultimate
healthcare stakeholder: the patient.
Spring 2016
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Physician enthusiasm levels are no barrier to adoption; oncologists greet breakthroughs with great excitement. Hall & Partners conducted post-conference research following the 2015 meeting of the American Society of Clinical Oncology (ASCO), and immunotherapies dominated attendee impressions of the event. 91% expressed feeling “extremely excited” about immunotherapies, with 73% stating they believed these advances will “completely change clinical practice.” Overall, oncologists reported feeling “optimistic,” “hopeful,” “empowered” and “inspired” by the future of cancer care.
This enthusiasm, however, can stall in the face of putting innovations in practice. Why? Because existing oncologist frameworks for assessing value—a treatment’s clinical benefit relative to toxicity and cost—focus heavily on price. Concerns over the costs of therapies appear to wield undue influence over physician-patient conversations, along with treatment decisions.
New drugs like nivolumab, palbociclib and pembrolizumab are, admittedly, extremely expensive. It is nonetheless troubling that 60% of ASCO attendees cited the cost of immunotherapies as a “big barrier” to adopting them in their practices—without substantive consideration of their value as perceived by patients. Lacking access to in-depth insights into patients’ wants, needs and preferences, physicians fill the gap with assumptions, inadvertently building powerful perceptions that shape both how they perceive innovations and how they direct patients to interpret their value.
Health care suffers no shortage of value assessment methodologies. Memorial Sloan Kettering Cancer Center, the American Board of Internal Medicine Foundation (ABIM), the Institute for Clinical and Economic Review (ICER), the National Comprehensive Cancer Network (NCCN) and ASCO have all created unique frameworks for evaluating protocols based on efficacy, safety, affordability, evidence, and other relevant factors. Physicians themselves are accustomed to balancing the need for good clinical outcomes with financial benefit to their practices.
But while these frameworks have succeeded in helping pharma convey treatments’ clinical benefits, physician reservations persist with regard to overall value (See Table 1). Tellingly, ASCO oncologists reported that they “always” or “often” discussed costs of the newest, most expensive treatments with patients. But when asked to assess even the most iconic, successful therapies (e.g., Herceptin, Gleevec), attendees’ perceptions of overall value suffered relative to clinical worth. Without additional insights to weigh, oncologists will retreat to considering quantifiable data, like price.
Notably underrepresented is the value determination framework of the patient, which comes with its own complexity. It is patients’ circumstances, not clinical benefit, that prescribe many of their treatment priorities, as most receive care while managing every other aspect of their lives. Toxicity can extend beyond physical discomfort; drug effects may threaten employment or necessitate child care. The same rings true for the benefits of strategically-selected interventions. Treatments received at the right cadence may prove a “lifesaver” in more ways than one.
It is the absence of the patient’s voice and perspective that leaves oncologists vulnerable to assumptions as they consider/assess the value of new innovations. And as long as cost remains a dominant topic within the industry-wide value discussion, it will remain difficult for oncologists to shift their own perspectives—and that of their patients. Should not researchers advance the search for value by embracing patient-centricity—providing pharma with models for understanding value through the lens of the patient experience?
Our research affirms that physicians would welcome these insights. Attendees credited ASCO with addressing value in 2015, but also expressed that their interest in the topic exceeded the conference’s focus on it. (Hall & Partners will return to ASCO 2016 to continue monitoring attitudes and practices.) By comprehensively mapping all factors—from cost to toxicity, from clinical outcomes to patient
quality-of-life considerations—pharma can respond to physicians’ hunger for the holistic, comprehensive discussions that will guide them to more patient-focused coverage.
Within these new frameworks, Hall & Partners sees rich potential for pharma brands to shepherd their breakthroughs into broader practice by developing greater responsiveness to patients’ motivations and behaviors—what they see, think, feel and do. Introducing this new calculus can mitigate oncologists’ disproportionate focus on cost, as new data displaces preconceptions. Patient-centric insights can complete a 360-degree model of value, one that extends far beyond clinical data and cost concerns to include the personal experience of care.
Only a model this rich, detailed and human can translate into new, effective brand communication platforms—ones that inspire oncologists to adopt immunotherapies and other innovations with full clarity and confidence in their value.
For further information, please contact:
Soumya Roy at [email protected]
PBIRG Perspective
13
INDUSTRY FORUM
A Multi-Faceted Approach to Patient AdherenceBy Keshia C. Maughn, MPH and
Ewa J. Kleczyk, PhD, Symphony Health Solutions
Patient adherence to therapy is an
essential component of improving
health outcomes. Non-adherence
to therapy can amplify long-term
healthcare costs, primarily through
increased comorbidities and
concomitant therapies and decreased
quality of life. It is estimated that the
economic cost of non-adherence to
therapy in the United States is 100 to
300 billion dollars annually1. This figure
includes the cost of avoidable care, as
well as wage loss from the increased
disease burden.
Understanding not only the current level of adherence within a patient population, but also the factors impacting that adherence, is an important part of managing healthcare costs. This article explains how predictive analytics can be employed to move beyond existing adherence measures to discover the key drivers of patient adherence to therapy.
Spring 2016
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Current Practices
Patient adherence to treatment and persistency of treatment are important to improving patient outcomes. There are two standard measures of adherence: Medical Possession Ratio (MPR) and Proportion of Days Covered (PDC). MPR compares the total days a product is supplied to a patient to the total time that has elapsed over the study period. MPR is best for measuring adherence for a single product with a daily treatment schedule, such as common diabetes and hypertension medications2.
PDC, by contrast, allows for the assessment of adherence when concomitant therapies should be taken into consideration. It is a more appropriate adherence metric in therapeutic areas where multiple-medication use and treatment switching is prevalent2.
Shortcomings of Current Methodologies
According to the Pharmacy Quality Alliance (PQA), MPR can overestimate adherence by failing to account for supply overlap periods when a patient switches therapies. While this limitation has led PDC to become the preferred adherence measure, PDC may underestimate adherence in situations where a patient refills a prescription early2.
Most importantly, these measures can be especially biased when assessing adherence in therapeutic areas with non-daily treatments, such as oncology and rheumatology.
Finally, MPR and PDC are static measures that do not permit insight into the factors most contributing to adherence within a patient population.
Benefits of Using Health Claims
Analysis of health claims data enables a comprehensive and time-sensitive view of patients’ interactions with the entire healthcare system. The application of predictive analytics to this data permits identification of the factors determining adherence, as well as the level of impact they have on patient behavior.
What are Adherence Risk Factors?
Non-adherence risk factors decrease the probability that patients will continue to follow treatment as directed by their physician. Common risk factors of non-adherence include patient demographics, comorbidities, concomitant therapies and payer coverage.
Identifying significant risk factors allows brand marketing teams to utilize resources more efficiently. Patient subgroups can be prioritized based on their size and probability of non-adherence; this information can then be incorporated into the overall marketing strategy in a way that is both effective and timely.
For example, if changing managed care organizations is a significant predictor of treatment non-adherence, companies could prevent drop-off or switching by offering prior authorization support to physicians during common benefit enrollment periods.
treatment adherence, but also the impact of the timing of that event. Furthermore, it is able to account for the impact of multiple factors in its estimates of adherence probability.
Future Directions
In future studies, exploratory machine learning algorithms could be leveraged to increase the predictive accuracy of adherence factor models. Social media data mining and natural language processing methodologies could be utilized to supplement claims data and account for the role of ‘personal’ factors in adherence decisions.
References
1. Adherence and health care costs. Iuga, Aurel O and McGuire, Maura J. 2014, Risk Management Healthcare Policy.
2. Nau, RPh, PhD, CPHQ, David. Proportion of Days Covered (PDC) as a Preferred Method of Measuring Medication Adherence. s.l. : Pharmacy Quality Alliance.
Benefits to Adherence Factor Modeling
There are two primary benefits to adherence factor modeling: its ability to consider time and its ability to consider multiple factors. Adherence factor modeling appropriately captures time variance. It not only examines the overall impact of a particular event on
