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Setting the record straight

How effective are attempts to measure marketing spend?

A tape measure measuring the length of a line of dollarsThe need to assess how effectively money is being spent to support a business' objectives is fundamental – credit crunch or not. It tracks the effect of current activity, enables future planning around successes and failures and can help to secure budget to repeat or build activities.

"Show me the RoI" used to be the cry, driven by the behind-the-scenes bean counters to justify every penny spent.They make a valuable point, ever-important as we face a tougher political and economic climate, but there are two clear-cut issues here.

Firstly, despite many expensive and theory-based propositions, such as 'econometrics', to separate out the 'value' of a marketing activity in the sense of the bottom line (sales generated by an activity) it is not possible in the real world to do this for the majority of marketing spend.

Exceptions include direct mailers that drive an increase in prescribing when there is no sales force or other promotional activity in a territory, or a local disease awareness campaign, in isolation, that sees more patients with a real need benefiting from appropriate treatment.

Secondly, and more fundamentally, let's address the indiscriminate exchange of the terms 'RoI' and evaluation. We need to set the record straight once and for all. Nirvana for the healthcare communications industry is demonstrating that the educational and informational activities it implements are having an effect and helping patients. Forget RoI, we need to talk about evaluation, measurables and cost/impact models.

As communicators, when we talk about healthcare communications – PR and medical education – we are seeking more intangible benefits than sales. Awareness, education and information are the drivers and the ABPI Code of Practice is clear on this: it states that any communication campaign measurement must relate to achieving better understanding and, ultimately, patient outcomes.

Don't for a minute think that this lets accountability off the hook. In a modern business environment, PR and med ed demands respect by being as, if not more, accountable than its long-established marketing bedfellows including advertising and direct mail.

Ensure all resources are deployed to give maximum impact – planning allows evaluation, which equals accountability.


Example of impact vs cost chart

Mapping out the totality of the communication mix in an impact vs cost chart is one possible tool for comparing the relative value of different types of activities. The Y axis charts low to high impact, while X axis maps low to high cost. Activities can then be plotted according to their value and groupings achieved from the attractive 'high impact, low cost' quadrant to the less attractive 'low impact, high cost'. The grid should be plotted by all involved in the marketing planning process following extensive discussion and debate. How it appears will differ according to the stage of the product lifecycle, the market dynamics, data available and other variables.


Diagram showing impact vs cost
Source: HCA Survey 2004



Bridge the gap! Planning for value
Communications people often sit in their own bubble and business people sit in theirs, each with a different language and views on what is worthwhile. To deliver effective campaigns, it is important to bridge this gap early on. A good, simple planning process will get dialogue going and help create a valuable communications campaign. It will also tell you what needs to be evaluated.

Discuss the commercial context
Most activities undertaken by communication companies are non promotional (and therefore cannot have the objective of driving sales) but it is important the communications team understand the whole commercial context. Getting into the 'commercial bubble' creates an important connection with the client. Remember, the Code accepts we are commercial organisations. If the intent of marketing communications activity is to benefit patients and improve the practice of medicine, it views commercial benefits as a happy consequence.

Plot the steps to success
Sit with the marketing team and ask them to draw a map – preferably a sequential flow chart – looking at what needs to happen at different stages to achieve commercial success. Then look at what are the barriers and drivers to success at each stage. Keep this informal, it's not a business model.

Agree specific goals for non-promotional activities at the start
Goals designed to create an appropriate environmental change, or increase disease awareness or education about the change or nature of disease management, can be made specific by putting 'markers of success' in place.

Two simple questions any campaign planner should be able to answer are: What are the objectives and what outcomes do we want to see from this communications programme?

Business and market knowledge for all
Invest in the whole team including communications to build their market environment and business knowledge. Make time to learn; market dynamics change rapidly and this is essential to being a good planner.

Be flexible and stay in touch
A plan written in January may need to be rewritten in March – markets move and need a fast response. 



Evaluating effectively
Ideally, 10 per cent of any budget should be spent on evaluation. But the reality is that when the budget is small often payers would rather invest in activity.

Evaluation need not be expensive
There are usually commercial resources already available or available data that can be used to benchmark. Once a benchmark is established, the only barrier to evaluation is lack of planning.

Evaluation is key to understanding programme effectiveness
There is a strong argument, when you know a marketing discipline works, to invest all the money in activity and not evaluation. But measurement demonstrates that non-promotional communications activities are effective and therefore money has been wisely spent.

Evaluation is a simple process
Define campaign objectives and look at ways of measuring your success. It need not be expensive as long as all parties – agency, client and third parties such as doctors or patient organisations are involved at early planning stages and prepared to monitor progress during and at the end of a campaign, according to agreed measures.

For example, if your objective is to educate patients to improve their health and your campaign is working via doctors treating those patients, take a sample of patients who have received the education and compare specific health outcomes with those who were not exposed to the education to demonstrate it works. The 2007 Brent tPCT Passion for Fasting education programme for Muslim patients did just this and has picked up awards from Diabetes UK, the European Diabetes Association and Communiqué and was a PMEA finalist, achieving valuable recognition for the lead clinicians on the project as well as the agency and sponsoring client.

Evaluation can maximise budget
Working in a pilot region or with a closely defined audience can mean it is easier to define and measure markers of success and outcomes. Once the principle is proven to work it then makes sense to roll out the programme with less rigorous evaluation and spend what might have been budgeted on implementation.

Evaluation stifles the creative process?
Assuming a significant proportion of your activities can be demonstrated to have a value, there should still be scope to allow for innovation.

Over the last three years, the quality of entries for Communiqué Awards has shown a quantum leap in terms applying simple evaluation criteria in campaign planning and pushing creative boundaries! 

Useful resource
The HCA Electronic Evaluation Toolkit is free to HCA members and allows teams or individuals to save and edit evaluation documents for their programmes. It should be used as part of the project design phase, helping executives think through every stage of each project and its evaluation. 


The Authors
Carys Thomas Ampofo MCIPR is director at Ash Healthcare and past chair HCA ROIE sub committee. Karen Moyse is principal at KineticFuture


Ask the expert: RoI with 'Code' clarity –
Dr Patricia Campbell, consultant in medical affairs 

How would the ABPI Code define RoI in relation to communications activities? Are we allowed to measure RoI under the Code?
The Code makes no reference to RoI per se. The successful implementation of promotional activities can legitimately be measured by RoI, but non-promotional activities must be measured in an alternative way. Many activities undertaken by communications companies are defined as non promotional, eg, provision of information (directly or indirectly) to the general public, medical and educational services, activities related to clinical research, activities undertaken before the licensing of a product or new indication, and dealings with patient organisations.

What has changed since the RCP report?
Publication of the RCP report earlier this year has drawn attention to the pervading concern about the extent to which patient organisations and HCP education, to name but two examples, are dependent on the industry for their funding. It seems likely that, with time, doctors may contribute more towards their own postgraduate education where, previously the industry has largely funded it, but time will tell. However, it is the pharmaceutical industry's own Codes (National, European and/or international depending on who we are representing) with which we must willingly comply.

If non-promotional pharma activity shouldn't be linked to sales, what measurement criteria is acceptable?

Where the activity is non promotional, RoI is inappropriate. These activities are legitimately designed to create an appropriate environmental change, increasing disease awareness or educating about the changing nature of disease management.

However, the decision to prescribe should be made by the prescriber on the basis of adequate balanced information. Some of which may come from PR activities undoubtedly, and certainly, messages conveyed must be fair and balanced and not disguise promotion but should increase understanding and education, with the aim of better overall patient care. It would be inappropriate to measure the success of the delivery of these educational messages, by measuring sales. Indeed to do so infers the intent was to increase sales suggesting a non-promotional activity was designed to be promotional. These activities however, are no less valuable to the industry, as improved understanding and awareness about diseases and their current management, may well improve care of patients, allowing greater access to drugs, which, in turn, will ultimately benefit the industry.

Are we allowed to set a commercial outcome as an objective?
A commercial outcome could encompass expansion of the market, and this is an acceptable aim without being product specific, but to measure sales of a particular product would be unacceptable. Providing all other parts of the marketing mix are in place, the company funding the market expansion may well benefit by getting a slice of the now larger pie, but that product specific measure would be related to the promotional campaign they are undertaking and not to the non-promotional activities.

Are we allowed to set a strategy which leads us towards a successful commercial outcome, eg, 'creating awareness'?
Creating awareness about a disease, or important and radical changes in the management of a disease, may be acceptable since ultimately this would lead to improved patient care. However, creating awareness of the availability of, or information about, a particular medicine could be interpreted as disguised promotion and would usually be inappropriate. The strategic objective to create disease awareness undoubtedly provides a more receptive environment for other product specific marketing and sales initiatives to take place, but these activities must be quite separate.

Which areas of pharmaceutical activity are particularly sensitive when it comes to measurement?
The success of any activity deemed to be non promotional is always going to be difficult to measure. A tangible effect on the ['bottom line' may be a positive side-effect of these activities, of course, but the success should be measured by measuring whatever is the intent of the activity… and this is not always easy to do. Nor does it always entirely satisfy the company's senior commercial management who, understandably, are driven by the commercial success of the business. For example, pharma companies have often funded non-promotional nurse teams to review patient management with the intent of improving patient care. If as a result of that review, the patient's management is improved and modernised this is of benefit to the patient and is perfectly Code compliant. Patient throughput may be an appropriate measure. The company may also benefit if the prescriber, with all the available information from a multitude of sources, decides that the company's drug is, in fact, most appropriate for the patient. But it would be unacceptable to  measure the success of the programme by measuring the effect on local sales as it would immediately link the (apparently) non-promotional activity with sales of a particular product, thereby turning the activity into a promotional activity – a clear breach of Code.

Measurement of success of patient support programmes may also present a problem, but since they are usually product-associated and only available to the patient once the decision to prescribe the drug has been made, it may be acceptable to measure success in terms of compliance with prescriptions which, in turn, reflects better patient management. However, increase in number of prescriptions as the sole measurement of success, could give the impression that improved sales figures were the sole motivation for providing the programme. The intent must be to provide patient support towards better health so a variety of measures should demonstrate that the programme is of benefit to patients and not simply a means of increasing sales.

Which areas in the PR and communications field could be particularly sensitive when it comes to measurement?
Disease awareness programmes must demonstrate the success in achieving greater awareness of the disease and not awareness of the company's related product. Of course there is likely to be a product promotional campaign involving sales teams and marketing activities at the same time, and creating the right environment can enhance these programmes, but the measurements of success should be specific to each initiative.

Likewise, a media campaign, which is by definition non promotional, should be measured in terms of understanding and awareness of the messages communicated within the campaign. The same is true of medical education through non-promotional scientific meetings supported by the industry. Improved education should lead to better understanding of the management of disease, which in turn, benefits patients. Although this education will form part of the information which leads to the decision to prescribe, it would be inappropriate to measure the success of the educational programme in terms of the number of prescriptions for a specific product, written by those attending the meeting.

In short, the objectives behind any non-promotional activities are likely to be environmentally based and these should provide the basis for the measurement of success of the activities. If success is measured in terms of RoI, the activity is linked to promotion. Since the majority of activities undertaken by communication companies tend to be non promotional in nature, we need to devise novel ways of measuring success.


2nd December 2009


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