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Launch target

Integrating patient education from the outset promises to reduce non-adherence and boost sales

radar New products are launched on a wave of educational materials and meetings aimed at healthcare professionals (HCPs). This ensures HCPs' awareness of new products and can change prescribing habits. However, in the months and years that follow the launch, patient non-adherence frequently becomes a problem and can prompt HCPs to switch their patients to other products. The pharmaceutical marketer's reaction to this is to implement an education programme aimed at the patient to improve adherence. So, why wait until non-adherence becomes a problem? Why not target the patient at launch?

Non-adherence to prescribed medication is common across most therapeutic areas (See Hidden blockbuster? in PM June 2009). Using an understanding of the factors that cause poor adherence to medicines, patient education to increase adherence can be integrated into a launch plan. This can prevent non-adherence becoming a problem, resulting in better patient outcomes, increased brand loyalty and, ultimately, increased sales revenues.

A widespread problem
It is estimated that a third to half of all medicines prescribed for long-term conditions are not taken as recommended. Adherence rates as low as 50 per cent have been reported in a diverse range of diseases and conditions, including hypertension, schizophrenia and even HIV.

Non-adherence not only represents a loss of potential revenue worth millions to pharmaceutical manufacturers, it also has a profound effect on the NHS and the patients themselves. Non-adherent patients are more likely to experience symptoms and disease deterioration. Worryingly, in diseases such as hypertension, which can lack obvious symptoms, the first sign of non-adherence could be a heart attack or stroke.

This increase in symptoms and in costly hospitalisations places an increased burden on the NHS. From the standpoint of a pharmaceutical marketer, this can lead to the frustrating situation where doctors are switching patients to other products despite the fact that the originally prescribed product is effective if taken properly. Moreover, if patients are frequently non-adherent to certain products, HCPs may simply regard these products as less effective.

Reasons for non-adherence
Non-adherence to medicines is attributed to several factors, which can be grouped into patient-related, HCP-related and medication-related factors. Patient-related factors can include complex psychological issues such as disease denial and fears associated with taking medication. A low level of understanding of either diagnosis or treatments can also play a part. Other patient-related factors include simple reasons such as people forgetting to take their pills.

HCP-related factors include whether the HCP informs the patient about possible side-effects and fully explains the consequences of non-adherence. Medication-related factors include the side-effects of the drug, which can be quite debilitating, as well as factors relating to the dosing of the drug, for example, the route of administration and the 'pill burden' (how many pills the patient is required to take per day).

For any one product, there will be a unique mix of factors contributing to non-adherence. It is perhaps confusion around these issues that prevents companies from tackling non-adherence.

However, many of the reasons for non-adherence should already be known before the product is launched. It is intuitive that some patients will be annoyed at having to take pills four times a day, or that an absence of symptoms can lead to patients thinking they no longer have to take medication. Indeed, unless the product is licensed in a completely new therapy area, many of the patient- and HCP-related factors causing non-adherence will already be known.

A new approach
Currently, HCPs are seen as the most important target audience at launch – after all, they are the people who prescribe the medication. However, when non-adherence becomes a problem, the patient swiftly becomes a target. A new approach that is already proving successful with some brands is the integration of patient education at launch. Making the patient as important as HCPs at launch addresses the issue of non-adherence from the start, ensuring that patients have the support they need to make informed health decisions. Acting early will reduce non-adherence and prolong sales growth.

Without patient education at launch

without-patient-edcuation-a

With patient education at launch

with-patient-education-at-l


Targeting the patient

Patient education programmes starting at launch will help patients trust the product because they feel supported. This can be increased by the inclusion of education on non-medication issues, such as disease awareness and how lifestyle factors might affect the disease. To maximise patient understanding, educational materials should be written in clear, concise and jargon-free language. Attaining buy-in from the patient is the key to long-term brand loyalty, and an understanding of the patient's needs and beliefs can help achieve this.

Success stories
Several pharmaceutical manufacturers are incorporating patient education into their brand launch programmes with good results. Following notable successes in the US, pharmaceutical marketers in the UK are now applying similar strategies. Examining some of these success stories can provide insights into the effectiveness of integrated patient education programmes.

Take, for instance, a synthetic hormone for the treatment of diabetes. When a new convenient injector was launched, its manufacturers faced the challenge of infiltrating an already crowded diabetes market. A patient-focused support programme was initiated using patient insights and raising awareness using direct mail, email and online education to reach the largest possible audience.

The programme was very successful; patient enrolment exceeded expectations by 80 per cent and more than 90 per cent of patients stayed on the therapy for the 4-6-month monitoring period. There was also universally positive feedback from HCPs, sales reps and patients.

Other successful examples include those designed for oncology patients. Starter kits, given to patients when treatment is initiated, have been used to support patients and increase drug sales. These kits include information about side-effects, coping strategies and practical tips, as well as treatment organisers and adherence reminders. In the case of a treatment for breast cancer, patient education materials that were integrated into an overall launch plan helped achieve 156 per cent of predicted sales in the first three months following launch.

Effective partnerships
Partnering with patient organisations can add to the credibility of educational activities and help reach a larger patient base. This approach was used to great effect for educational materials relating to a novel therapy for cutaneous T-cell lymphoma (CTCL). In this example, a partnership with the Cutaneous Lymphoma Foundation (CLF) was initiated, which led to the development of a treatment tracker. The partnership allowed treatment trackers to be distributed at CLF events and via the CLF website, thus reaching a substantially greater proportion of the estimated 20,000 US patients with CTCL. In addition to helping patients, the tracker also raised the pharmaceutical company's profile among HCPs by demonstrating its commitment to patient support.

Can you afford not to?
Patient empowerment is the key to improved adherence to medicines. In order for patients to make appropriate decisions about their healthcare, they must have a good understanding of their condition, the treatments available and the health benefits of adhering to their treatment plan. Providing this information at launch can help avoid the problem of non-adherence before it impacts on sales.

It is also an important building block in developing long-term trust between patients, HCPs and pharmaceutical companies. Conversely, a lack of patient educational programmes at launch can lead to a failure to reach maximum sales potential as HCPs transfer non-adherent patients to other products.

In a market where the patient is becoming increasingly important in making informed healthcare decisions, pharmaceutical manufacturers cannot afford to omit them from their launch plans.

The Author
Noel Curtis is head of editorial services at HealthEd
To comment on this article, email pm@pmlive.com

5th August 2009

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