Patient support programmes within medicines optimisation – the pros and cons

Patient support programmes within medicines optimisation – the pros and cons

Andy Carter | Director of StrategyAtlantis Healthcare

Patient Support Programmes within medicines optimisation

“Good commercial value or bad investment”

Andy CarterDirector of Strategy, Atlantis Healthcare

Adherence to long-term therapy for chronic illnesses in developed countries

averages 50%. In developing countries, the rates are even lower1

1. WHO: adherence to long-term therapies: Evidence for action. 2003

1. IMS Institute for Healthcare Informatics – Advancing the responsible use of medicines: Applying levers for change, Oct 2012

The health spending that can be avoided in this way amounts to 8% of total annual health expenditures worldwide1

"Responsible" meds use can save $500B/year globally

More than half ($269B) can be gained through improved patient adherence, according to the report1

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Medication optimisation is on the UK’s agenda

Royal Pharmaceutical SocietyMedicines Optimisation: Helping patients to make the most of medicines May 2013

CG76 Medicines adherence: NICE guideline Jan 2009

£300m medicines wastage v’s £500m/year estimated opportunity cost of health gains foregone due to meds optimisation1

1.York Health Economics Consortium & the school of pharmacy, university of London, Evaluation of the scale, causes and costs waste medicines 2010

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Pharma investment reacting to medicines optimisation agenda

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Non adherence transcends all conditions

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Cochrane - acknowledges the importance of medication adherence

“Effective ways to help people follow medical treatments could have

far larger effects on health than any treatment itself”

1.Cochrane review: “Interventions for enhancing medication adherence” 2008

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Poor adherence is costing pharma hugely in lost revenue

Even a modest 10% increase in adherence could lead to a significant rise in revenues, accompanied by improved health outcomes and decreased

healthcare spending.

Global pharmaceutical market revenue loss is estimated to be $564 billion, or 59% of total global pharmaceutical revenue in 2011

Firlik K et al, Estimated Annual Pharmaceutical Revenue Loss Due to Medication Non-Adherence, Nov 12

The evidence to date

Patient adherence interventions / support

Inconclusive findings - but acknowledged scarcity of evidence

Haynes et al, Interventions for enhancing medication adherence. Cochrane database of systemic reviews 2008, Issue 2

Authors’ conclusions:

“For short term treatments, several quite simple interventions increased adherence & improved patient outcomes, but the effects were inconsistent from study to

study.”

“For chronic conditions, interventions are mostly complex and not very effective.”

Short term treatments - 5/10 interventions improved adherence- 4/10 interventions improved clinical outcomes

Long-term treatments - 36/83 (43%) interventions improved adherence - 26/83 (31%) interventions improved clinical outcomes

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A consistent weakness in research to date around adherence

NHS – SDO CRITICAL REVIEWHorne, Weinman et al, 2006

• A narrow focus & failure to consider both intentional and unintentional non adherence

• “One-size-fits-all approach” (i.e. not personalised)

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Perceptions & health beliefs drive intentional non-adherence

The impact of personalised interventionsProduct All preventer inhalersProgramme name Asthma AIMPublication Published British Journal of

Health Psychology

Overview

• A scalable intervention programme designed to increase adherence to asthma preventative medication

• Programme developed in conjunction with the University of Auckland and supported by Vodafone

• Programme conducted as part of a randomised controlled trial (RCT)

• Programme comprises 18 week text message package tailored to the individual’s illness perceptions & medication beliefs

A study targeting patient beliefs to improve adherence

Improved adherence in asthma intervention group

Adhe

renc

e %

Average adherence over all time points was 43.2% in control group v’s 57.8% in intervention group

Keith J. Petrie, 2012, A Text Message Programme Designed to Modify Patients’ Illness and Treatment Beliefs improves Self-Reported, Adherence to Asthma Preventer Medication, British Journal of Health Psychology 17, 74-84.

Personalised programmes can deliver lasting behaviour change

Baseline 6 Weeks 12 Weeks 18 Weeks 6 Months 9 months0

10

20

30

40

50

60

70

Control Intervention Group

Aver

age

Adhe

renc

e %

Intervention ceases at 18 weeks, adherent behaviour continues

Average adherence over all time points was 43.2% in control group v’s 57.8% in intervention group

Keith J. Petrie, 2012, A Text Message Programme Designed to Modify Patients’ Illness and Treatment Beliefs improves Self-Reported, Adherence to Asthma Preventer Medication, British Journal of Health Psychology 17, 74-84.

Patient support programmes with personalised interventions

- Delivering positive ROI

HCP’s differentiate brands with patient support programme

Specialist physicians surveyed - 61% stated the availability of the patient

support programme would likely impact on their choice of treatment

Independent market research 2013 – data on file

Patient support programmePatients with wet age related macular degeneration (AMD)

12 month patient support. Interventions included:- seminars- nurse calls- welcome packs for carers & patients- Self monitoring tools- DVD’s & Audio

Strategy 1. Empower patients to take control2. Create a patient support programme that is valued by patients and is recognised

by HCP’s3. Differentiate product from its competitors

Atlantis Healthcare - Data on file

Programme running for 5 years due to positive commercial return

Commercial return prolific

• 8 fold decrease in drop out – 3% of patients on the program discontinued treatment versus 24% not on the program

• Patients on the program have on average 2.5 additional scripts per annum

• 3,000 patients enrolled

• ROI = 941%

Average number of treatments per time period

n 3 mths 6 mths 9 mths 12 mths 15 mths

Non PSP 2645 2.78 4.30 5.38 6.22 7.00

PSP 316 3.20 5.52 7.21 8.70 10.38

Atlantis Healthcare - Data on file

The ability to develop value propositions

Roebuck C, Liberman J, Gemmill-Toyama M et al. Medication adherence leads to lower health care use and costs despite increased drug spending. Health Affairs, 30, no.1 (2011):91-99

Therapy area Return on investmentChronic heart failure 8.4 : 1Hypertension 10.1 : 1Diabetes 6.7 : 1Dyslipidaemia 3.1 : 1

Key learnings & recommendations

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Steps for developing the case for an adherence strategy

BUSINESS CASE Including summary of key opportunity, alignment needs, implementation needs, recommended

skeleton solution overview (outcomes, measurement, budget, timings, CSFs)

Adherence issues and opportunities

identified?

The organisation is aligned to address

these issues?

Solution framework and implementation

considerations developed?

Investment defined, and potential impact

assessed?

1 2 3 4

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Investment needs to be better distributed between acquisition & retention

Oliver Wyman Report: A Prescription for Change: The New Go-to-Market Model for the Pharmaceutical Industry 2009.

Effective AdherenceSolutionsMarketing budget spend

89% v’s 10% v’s 1%On patient Payor On patientacquisition marketing retention

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Adherence strategies can deliver for ALL stakeholders

PatientsDo more, feel better, live

longer

Personalised solutions

PharmaImproved sales from existing

patients

Improved market access

Competitor differentiation

HealthcareImproved outcomes

Reduced wastage

Lower healthcare utilisation