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The business case for patient engagement

Using digital to bridge the engagement gap between patients and pharma

Sebastian

While some pharma companies have embraced patient engagement and pushed innovation, others have been wary of committing the resources to something that is not tried and tested, with no guaranteed return on investment. 

This article looks at three reasons why the business case for patient engagement is a strong one.

1. Adherence pays off, and so does persistence

The overwhelming human and financial cost of medication non-adherence is generally quantified with large population-level numbers, quite rightly putting great weight on aspects such as avoidable hospitalisations and sub- optimal outcomes. The cost of non-adherence on a pharmaceutical product level is rarely considered in isolation.

It is at a product level, however, that pharma can effectively engage patients for better adherence. But does it pay off beyond the important, but intangible, benefits of patient safety? What level of engagement would pharma need to aim for to make it a business case?

The beauty of effective patient engagement is that it does not only increase the share of prescriptions filled – improving what is usually called primary adherence – but it also extends the time patients stay on the drug, therefore simultaneously improving persistence. This double dividend is key when trying to quantify the value of patient engagement.

Take a fictional medication costing $1,200 per month that has an average adherence of 50% and an average persistence of eight months. Looking at adherence and persistence in isolation, boosting per-patient sales by 20% requires an adherence increase of ten percentage points or a persistence increase of 1.5 months. However, an effective engagement initiative will affect both.

As the lines in the Adherence and Persistence graph illustrate, different combinations of increased adherence and persistence can deliver the very same 20% sales boost. An initiative that increases adherence by only 6 percentage points and persistence by 0.5 months would move a patient from point A in the chart to point B – and deliver the desired 20%.

Patient engagement can address many of the vastly complicated and personal reasons that lead to both poor adherence and poor persistence.

Meaningful engagement offerings are not one-size-fits-all; rather, they can be used to add real value to patients
and encourage them to take medications as intended. It is not just patient engagement; it is personal engagement. And, as this exploration shows, it can subsequently boost sales for the many drugs that are particularly susceptible to poor adherence and persistence.

graph

2. Brand recognition pays off

The scope of pharma’s ability to shape brand perception among patients varies around the world, with only the USA and New Zealand permitting direct-to-consumer advertising. Even in those countries, it has traditionally been perceived as most valuable to direct the bulk of marketing efforts towards those who write the prescriptions rather than towards those who fill them.

The digital world in which we now live is changing the possibilities for meaningful interactions with patients. Digital channels offer pharma companies a new line of communication, to directly support patients in their treatment, inform and educate, generate valuable feedback, and safeguard real-world outcomes.

When pharma does this directly, it brings the company behind the drug into patients’ consciousness far more than has traditionally been the case.

Should pharma make use of this opportunity and invest in patient engagement to build brand recognition with users of its products? We would argue so. The days of uni-directional doctor-to-patient communications are long gone, and a safe and effective product will only get you so far.

Patients have become important influencers regarding prescription decisions – not only for themselves but also for other patients. Without patients being confident and vocal about a product, doctors will be less inclined to prescribe it.

This effect becomes even stronger when patients also share their positive experience with friends and family members living with the same condition: requests for specific medications have been shown to dramatically affect prescriptions.

But why not let a product’s evidence speak for itself? We found that patients’ confidence and propensity to promote can differ significantly, even among very comparable products such as NOACs.

Over three days in spring 2019, we ran a short, ten-question questionnaire (Patients’ attitudes towards NOACs) for nearly 850 anticoagulation patients using MyTherapy, our medication and disease management app.

The results, as depicted in the chart, suggest that patients are equally likely to promote Xarelto and Eliquis, despite the latter earning more confidence. More notably, Lixiana users are far less likely to promote the drug than Xarelto or Pradaxa users, despite having a similar level of confidence in the drug as Xarelto users and significantly more confidence than Pradaxa users.

Are Lixiana users missing the confidence that Xarelto and Eliquis users have, and is this what influences their propensity to promote the drugs? Patient engagement and brand perception may not be the only answer to that question but, in the digital era, it is not far- fetched to believe it plays a role.

The results also suggest that even the drugs that are performing well have room for improvement regarding patients’ understanding of their treatment and value of the drug. Patient engagement can help improve these aspects, further enhancing a brand’s recognition in the eyes of patients.

graph

3. Digital medicines (DTx): can you afford to stay out?

In most developed markets, healthcare spending, measured as a percentage of GDP, has reached a plateau. There is reason to believe that within this pie, the spending on medicine is similarly stable. Once reimbursed, digital medicines may well start eating into this spending, effectively shrinking the market for pharma’s traditional products.

Of course, there are a lot of ‘ifs’ and assumptions involved, but can pharma afford to wait and see? Companies like Novartis have started to embrace digital medicines as part of the core business. Looking at recent developments, we believe that they have been well advised.

a) Digital medicines are increasing in number and scope; they can be supplementary to pharmaceuticals or even replacements for them. Prime examples of cognitive behavioural therapy programmes for substance and opioid use disorder are reSET and reSET-O.

Welldoc says its BlueStar digital assistant for people with type 2 diabetes is clinically proven to reduce the need for medications and supplies. A range of digital medicines is being developed for mental illnesses.

For cardiovascular diseases, researchers claim changing patient behaviour would have more of an impact than any traditional medication currently in development. Over the last years, a considerable digital medicines pipeline has emerged, and the list is only going to get longer.

b) Reimbursement models are evolving. Until recently, reimbursement was rather indirect, for example, by using digital medicines for safeguarding pay-for-performance deals and value-based reimbursement models.

The next step is direct reimbursement of digital medicines, and Germany is leading the pack. Its recent Digital Care Act (Digitale- Versorgung-Gesetz) will become effective as of January 2020 and make technology such as apps prescribable if they have evidence for efficacy and live up to standards in privacy and data security.

Effectively, the German assessment and reimbursement mechanism for digital medicines will not be too dissimilar to the way it assesses and reimburses non- digital medicines. Other countries will surely follow suit.

c) Digital medicines require a new set of capabilities that go far beyond digital product development and can hardly be built overnight. For any digital product, achieving effective engagement and retention requires many iterations with actual users – just look at online gaming and how much it has evolved over the years.

For an industry that is infamous for talking a lot about patients but not so much to patients, establishing and acting on this feedback loop is a whole new challenge.

On the whole, it looks as though digital medicines are moving ever closer to pharma’s core business. Waiting on the sidelines to see if and when digital medicines will really go mainstream is one strategy. Another strategy is to start building the capabilities and embracing the opportunity before the head start that digital medicines have makes them impossible to catch.

The business case: good for today, essential for tomorrow

Historically, significant engagement has not existed between patients and the pharmaceutical industry, between whom there has always existed a large level of detachment. Technology allows this gap to be bridged.

The bridge is gradually being built by large tech firms, start-ups and policymakers. Pharma companies that embrace its construction can make it an immediate business case, be it through adherence/ persistence, brand recognition, or both.

However, most importantly, they have the chance to use this bridge to deliver a future core of their business: digital medicines.

Sebastian Gaede is a founder of smartpatient, a Munich-based provider of digitally enabled patient support offerings

3rd October 2019

From: Marketing

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