The issue of patient compliance is largely unaddressed and chronically underfunded. In order to get more money dedicated to programs that will improve patient education and adherence, teams must demonstrate a likely return on investment. How can companies wishing to increase compliance show sufficient success on limited budgets and with few tools to merit greater investment?
Morna Butler, Executive Director, Innovex Global Operations, Quintiles Transnational and Jacco Keja, Vice President, Quintiles Consulting, Quintiles Transnational believe that with some innovative approaches to the question of compliance, companies can do a lot with a little.
Why comply?
Patient compliance, while it has dramatic effects on the patients involved, has far-reaching consequences. Says Butler, 125,000 people a year die from not following their prescriptions correctly. From 33-69% of hospital admissions and 23% of nursing home admissions are the direct result of patient non-compliance. Hospitalization costs come to around $13 billion, and the amount of lost productivity tops off at more than $50 billion.
The effect on pharma, says Butler, isn’t simply in lost revenue, though those estimates run anywhere from $30 billion to $70 billion. The true impact on pharma comes when patients’ non-adherence results in a “real-world” perception of a lack of efficacy and a lack of safety.
Why doesn’t pharma do more?
Pharma companies have numerous reasons for engaging the problem less aggressively than they should. Compliance programs generally represent a significant, long-term investment, and the returns are slow in coming. Most companies, with investors to consider, are interested primarily in the short term.
Equally, compliance programs tend to be burdensomely complicated. They may require contributions from throughout a company, with cross-functional teams and numerous players. Regulations are also a factor in pharma’s reluctance to do more on the issue of compliance. Butler says that within pharma there exists a perception that “a maze of regulations are difficult to navigate” – too difficult for efforts to be worthwhile.
Finally, says Butler, there is the question of ROI. Asks Butler, “how can we extrapolate compliance programs within the marketing mix and demonstrate achievement?” Just identifying the metrics can be a complicated enough process to dissuade many companies from taking on the compliance issue.
However, Butler says, improving compliance has potentially enormous benefits for all stakeholders in the health care chain. If we improve compliance, we improve patient outcomes, resulting in massive health care cost reductions, better relationships between doctors and patients, healthier patients and ultimately, benefits for pharma.
So what’s the big idea?
Innovation and implementation, according to Butler, can achieve big results on limited budgets. One approach she suggests is to “create maximum value with programs that deliver multiple objectives.” There are programs existing already within pharma companies that could be tweaked or expanded to allow for a patient education and compliance element. While compliance may not be that program’s primary aim, it can still be one of the program’s results.
One example of including compliance goals under a different program, says Jacco Keja, is to look at how companies gather data on market access. Nowadays, payers are interested in risk-sharing pricing strategies, for example. Rather than agree on a set reimbursement price for a therapy, payers prefer to set temporary prices, with the understanding that that price may change when the results on the therapy’s efficacy start coming in. It is in the pharma company’s interest, in that case, to generate “robust, real-life outcomes” data, says Keja.
Payers, says Keja, are demanding price justification for the costs of therapies and “real world” evidence of efficacy. The increasing popularity of risk-management plans means that pharma had better be able to generate promising results and demonstrate product safety in its “real-life” studies. Those robust results, as Keja calls them, can only be improved when the patients taking the medications during probationary periods are compliant. If elements of patient education and compliance are rolled into the programs primarily intended to gather market access data, then all objectives can be more successfully supported. Not only does this approach achieve multiple objectives, it does so in a highly cost-effective way.
Implementation by design
According to Butler, there are ways to generate extra value by planning strategic implementation. Actually putting plans into action is where many good ideas fall by the wayside. One way to ensure implementation is to have a process that reaps multiple, diverse benefits.
Using the results from educated, adherent patients to demonstrate safety and efficacy are certainly admirable goals and can generate good ROI; designing the implementation program with an aim to long-term objectives can increase the value of that program. Says Butler, consider tailoring your program with an aim towards publishing your results. “Strategic publication” to tell about what you’ve done generates extra revenue, publicity and value.
Therefore, the design of a program prior to implementation is critical, Butler says. This is the point at which companies need to be willing to make some investment. Before you begin, advises Butler, determine the objectives you are trying to achieve. If you’re looking at outcomes—be they clinical, economic, utility or humanistic—“design your program to have that baseline.” Decide in advance what the final measurements will be, and demonstrate what Butler calls your “ROE, return on education,” on that basis. If a program isn’t carefully and thoughtfully designed, chances of success are dramatically reduced.
Author: Shannon Perry, journalist, eyeforpharma
