How to Release the Hidden Value from Patient Non-Adherence: Part 1
Due to the plethora of causes for patient non-adherence, there is no single panacea to rectify the problem. *Abstract*
By on Apr 28, 2008Due to the plethora of causes for patient non-adherence, there is no single panacea to rectify the problem.
Abstract
Non-adherence to prescribed medications, particularly for long-term conditions, costs the global pharmaceutical industry an estimated $30 billion per annum. This represents a significant loss for pharmaceutical companies who have spent millions in marketing to get those initial prescriptions. Many different patient compliance / adherence programs are implemented by brand marketers to address this issue. However, unless they also evaluate the underlying causes for non-adherence for their brand, as well as the bottom line return on investment for specific adherence activities - and take these into account when designing and implementing the patient adherence programs - their efforts may well be doomed to failure. Given recent press reports on drug safety issues, as well as declining sales, greater competition, weaker pipelines, and increasing pressure to reduce direct-to-consumer (DTC) advertising expenditure, pharmaceutical companies can no longer ignore the hidden value available in increasing patient adherence to brands already being prescribed.
Background
Today, an estimated 70% of patients who begin a pharmaceutical therapy discontinue it within one year. This includes those with chronic conditions that require ongoing drug treatment to prevent progression of the illness(1).Frost and Sullivan report that one-third of all prescriptions are never filled and patient adherence with medications for chronic conditions averages only 50%. This represents a significant loss - both in terms of real revenue and opportunity costs - for pharmaceutical companies that have spent millions in marketing to gain those initial prescriptions(2).
Sometimes adherence levels are even lower: depression adherence rates hover between 32%-40% after three months(3), antihypertensive and lipid-lowering adherence rates are around 30% after six months(4), and diabetes adherence rates are 15%-33%(5). Even potentially terminal conditions do not escape this fate; oral formulation chemotherapy drugs suffer from adherence rates of only 50% after four years(6), transplant anti-rejection drugs adherence rates are 48% after one year(7) and HIV adherence rates are 33% after one year(8). And yet, although pharmaceutical companies spend the vast majority of their marketing budgets on capturing initial market share, few allocate more than 3% of their marketing budgets to retaining patients.
Considering that this lack of patient adherence costs the global pharmaceutical industry an estimated $30 billion a year, increasing adherence by 5% for a product with approximately $1 billion in sales, can translate to an additional $30 to $40 million in annual revenue(9). Thus, by not taking the time to understand and address patient adherence issues appropriately, many companies are missing a valuable opportunity to increase sales by implementing relevant strategies to increase adherence and persistence with their products.
How Can This Value Be Released?
Due to the plethora of causes for patient non-adherence, there is no single panacea to rectify the problem. Many approaches to increasing adherence are available. These include patient education, cost related approaches, direct to consumer advertising, packaging, delivery options and dosing regimens, call center support, Short Messaging Services (SMS), pharmacy interventions, patient assistance programs, drug discount and loyalty card programs, patient experience programs, changing patient beliefs, providing reminder systems, involving family members, training physicians, and electronic medical records programs. However, these programs are doomed to fail unless the marketer fully understands the specific causes for non-adherence which differ from one therapy area to another and from one drug to another.
The marketer also needs to take account of the current environmental influence (as environmental factors also play into the situation), and to understand the financial impact of the different factors involved. Patient adherence programs must only be implemented after a complete understanding of the underlying reasons for patient non-adherence, and with a firm grasp of their potential impact on the brands financial results and market share.
Any program implemented must be able to provide improved adherence to the brand, as well as improved bottom line profit for the brand and to do this companies must also:
evaluate underlying specific causes for non-adherence with their brand to guide the programs implementation,
address barriers to implementation,
understand the bottom line return for specific adherence activities.
When considering the return on the bottom line of adherence programs, the most important potential benefit is the additional prescriptions and resulting bottom line profit that could be realized through implementing such a program. Most published reports of ROI with medication adherence programs focus on overall medical costs.
One program assessed the cost-effectiveness of a collaborative care program for patients with depression, finding a significant clinical improvement for a moderate additional cost. The collaborative care included patient education, an initial visit with a consulting psychiatrist, shared care between the psychiatrist and primary care physician, and monitoring of follow-up visits and adherence to medication regimen. Patients receiving the collaborative care experienced an average of 16.7 more depression-free days over six months than the control group, resulting in an incremental cost-effectiveness of $21.44 per depression-free day (11).
Consider the use of a cell phone reminder system in a therapy area in which forgetting to take medication is the key issue underlying non-adherence. Even if only 6.5% of their patient population participates, increasing their adherence rate from the typical 40% to 85%, for a drug that generates 2 million prescriptions a year at a cost of $80 a month this could lead to increased revenues of $45 million. If the intervention costs $5 per patient per month, then companies could realize an ROI of 300% to 600% (12).
However, an adherence program comparing the use of the MEMS system with usual care in 253 hypertensive patients with poor adherence found no significant difference in cost or clinical outcomes, most likely because memory issues were not the underlying reason for non-adherence(13). This shows that without a thorough understanding of the underlying causes for your brand, no matter how good the adherence program, it has a hit and miss chance of succeeding.
However, there are ways that pharma marketers can release the hidden value measurably. For one brand that took this approach, the increase in patient adherence meant an extra $67 million on the bottom line from improved adherence alone in patients already being prescribed their drug. Their story and what they did will be outlined in next months newsletter!
For more information on how to apply analytics to releasing the hidden value from your patient non-adherence, please contact the author Dr. Andree K. Bates at www.eularis.com.
Author: Andree K. Bates, eularis
References
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2. Frost and Sullivan. Patient nonadherence: Tools for combating persistence and adherence issues 2005.
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4. Osterberg L, Blaschke T. Adherence to Medication. N Engl J Med. 2005;353(5):487-497.
5. Harris Interactive. Prescription Drug adherence a Significant Challenge for Many Patients. March 29, 2005; http://www.harrisinteractive.com/news/allnewsbydate.asp?NewsID=904. Accessed October 18, 2007.
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7. Kaiser Permanente Care Management Institute. Depression clinical practice guidelines. http://www.guideline.gov/summary/summary.aspx?doc_id=9632&nbr=5152&ss=6&.... Accessed May 2, 2007.
8. Demyttenaere K, Enzlin P, Dewe W, et al. adherence with antidepressants in a primary care setting, 1: Beyond lack of efficacy and adverse events. J Clin Psychiatry. 2001;62 Suppl 22:30-33
9. Bates AK. How to measure patient adherence and adherence ROI. http://www.eularis.com/articles/marketing-roi/How-to-add-muscle-to-patie...
10. Haynes RB, Sackett DL, Gibson ES, et al. Improvement of medication adherence in uncontrolled hypertension. Lancet. 1976;1(7972):1265-1268.
11. eyeforpharma. Improving patient adherence with low-cost wireless technologies. www.eyeforpharma.com/print.asp?news=52964. Accessed October 20, 2007.
12. Arar NH, Wen L, McGrath J, Steinbach R, Pugh JA. Communicating about medications during primary care outpatient visits: the role of electronic medical records. Inform Prim Care. 2005;13(1):13-22.
13. Brunenberg DE, Wetzels GE, Nelemans PJ, et al. Cost effectiveness of an adherence-improving programme in hypertensive patients. Pharmacoeconomics. 2007;25(3):239-251.