Market Report Source

Overview

Introduction
Failure to take medication as prescribed significantly increases the risk that patients will experience complications resulting in injury or death, and propagate higher healthcare costs overall. The medical establishment’s approach to adherence is changing as it becomes clear that the responsibility of achieving adherence is not solely the patient’s, but rather is shared among stakeholders.

Scope of this report

• Analysis of what is meant by adherence, how adherent behavior of measured and the factors that impact whether a patient follows treatment advice
• Examination of the factors individual, economic and societal factors that influence whether a patient will remain adherent
• Assessment of the healthcare trends that are impacting adherence to drugs worldwide
• In depth case study analysis of programs created by governments and industry in order to foster adherence in chronically ill patient populations

Research and analysis highlights
Physicians who do not take the time to understand their patients can negatively impact adherence by failing to take into consideration factors that may make it difficult for patients to follow a medication regimen. This can lead to physicians prescribing treatments that are prohibitively complex or missing opportunities to provide support services.

The ideal approach would involve collaboration between a variety of stakeholders, including physicians, patient groups, payers and the pharmaceutical industry. However, collaboration has proven to be complicated, not least of all because there is little or no consensus about how to define or measure adherence.

Reaching customers through customized interactions will help to make them feel as though they are valued and understood by the company. Furthermore, as regards disease management programs in particular, the more accurately targeted the program the more likely it is to effect a behavioral change in the patient.

Key reasons to read this report

• Learn how communication between patients, physicians and the pharmaceutical industry impacts rates of adherence
• Assess pharmaceutical industry-specific issues surrounding disease management and drug adherence in the US and 5EU
• Gain insight into the role of technology in disease management and drug adherence

Table of Contents

CHAPTER 1 EXECUTIVE SUMMARY

Scope of the report

Key findings

CHAPTER 2 THE PROBLEM OF NON-ADHERENCE

Evolution of the issue

Defining adherence

Compliance

Persistence

Concordance

Adherence

Identifying non-adherence

The impact of non-adherence

Factors affecting adherence

Filling and refilling a prescription

Moving past seeing adherence as solely the patient’s problem

Societal, cultural and economic

Socio-economic status

Culture and religion

Age

Disease and therapy

Diabetes therapy

Hormonal contraception

ADHD therapy

Antidyslipidemics

Healthcare system

Treatment team

Patient

CHAPTER 3 DISEASE MANAGEMENT

The growing importance of managing chronic disease

Cases of chronic disease are on the rise

Obesity

Tobacco use

Alcohol consumption

Sicker patients are living longer

The rise in the cost of healthcare is not sustainable

Disease management is a shared responsibility

Payers

Pharmaceutical companies

Patients

Society

National approaches to disease management

United States-government programs embrace personal responsibility and pay-for-performance initiatives

Medicaid and Medicare are both government-run healthcare assistance programs, with several key differences:

 Medicare is a federal public health insurance system that pays for health services, including doctors’ visits and hospital care. Individuals must be at least 65 years of age or disabled to be eligible for coverage.

Medicaid’s ‘personal responsibility’ reward programs may negatively impact adherence rates

Medicare’s Health Support program focuses on improving outcomes while cutting costs

United Kingdom-physicians are incentivized to focus more on adherence at the point-of-care

France-legislature decides that pharmaceutical-sponsored adherence programs are essentially advertising

Singapore-leading the way in the management of non-communicable disease in Asia

Collaboration between stakeholders

Treatment teams and patients

Time-pressed physicians can leverage online resources to provide patients with information and support for many of the medications they commonly prescribe

Nurses and pharmacists are ideally placed to play a bigger role in patient education and support

Case study: NHS Direct

Case study: Asheville project

Patient-employer (US-specific)

Case study: Pitney Bowes

Patient-patient

Case study: http://www.CancerCompass.com

Patient-pharmaceutical company

Case study: The Bipolar Adherence Program for Seroquel

Common program models

Support for patients who are capable of self-management

Support services for patients who struggle with adherence

In-person support/visits

Call centers

Online and mobile programs

Caregiver support

CHAPTER 4 PHARMACEUTICAL INDUSTRY-SPECIFIC CONSIDERATIONS

Adherence through the lifecycle of a drug

Clinical trials

Pre-launch and market entry

Market expansion and maturity

A role for electronic prescribing in adherence

CRM offers pharmaceutical companies a tool to tackle adherence programs

Branded and non-branded pharmaceutical-sponsored disease management programs

Pharmaceutical company-sponsored disease management and drug adherence programs

Considerations when developing a drug adherence and disease management strategy

Regulatory considerations-when is disease management marketing?

The language of adherence-why is patient-friendly communication important?

CHAPTER 5 THE FUTURE OF DISEASE MANAGEMENT AND DRUG ADHERENCE

Suggested strategies to improve adherence

Low tech-e.g., compliance packaging

Mid tech-e.g., integrated online and offline programs

High tech-e.g., merging compliance data into patient health records

Drug adherence and disease management-present problems and future directions

CHAPTER 6 BIBLIOGRAPHY

Cited publications and online articles

Further reading

Datamonitor resources

APPENDIX

Definitions and abbreviations

Currency Table

Extended methodology

Datamonitor interviews

List of Tables

Table 1: The terms ‘adherence’, ‘persistence’ and ‘concordance’ are believed to be more accurate terms to describe patient behavior, but remain underused

Table 2: Prevalence of lifestyle factors that contribute to chronic non-communicable diseases in key markets

Table 3: Medicare Health Support Pilot Programs in eight regions across the US

Table 4: The market for online and mobile adherence and disease management solutions continues to expand

Table 5: Research and development expenditure continues to rise globally, particularly in the US market

Table 6: Average 2006 exchange rates

List of Figures

Figure 1: The language used to describe adherence is critical to creating a clear understanding of the issues surrounding treatment

Figure 2: In both the Journal of the American Medical Association (JAMA) and the British Medical Journal (BMJ) the term ‘compliance’ appears less frequently in published papers than it did several years ago

Figure 3: 1-year rates of persistency vary considerably depending on the definition of persistence applied to a patient

Figure 4: Relying on self-reported levels of adherence at the point-of-care leads most physicians to significantly over-estimate patient adherence and persistence with treatment

Figure 5: Non-adherence is a shared problem among many

Figure 6: Causes of non-adherence can originate with either the drug therapy or the patient

Figure 7: Current estimates assume an approximate 50% adherence rate to prescribed medications in developed markets, but this does not ensure that medications are being taken as prescribed

Figure 8: Adherence is an extremely complex issue involving several layered factors, many of which are outside of the control of patients

Figure 9: Most patients are unintentionally non-adherent

Figure 10: Due to the rise in obesity, diabetes and diabetes-related complications are among the more significant burdens on the US healthcare system

Figure 11: Advances in medicine have made it possible for patients to live longer despite chronic illnesses – life expectancy across the seven major markets, 1960-2006

Figure 12: Per capita expenditure on health has risen dramatically in the us since the 1990s

Figure 13: Pharmaceutical companies can work with physicians to provide patients with much-needed education programs and disease management tools

Figure 14: The nurses that staff the NHS Direct telephone lines provide patients with a range of support services and information

Figure 15: Local pharmacists are ideally positioned to serve as points-of-care for patients at risk for non-adherence

Figure 16: Pitney Bowes provides a model for how employer investment in preventive care and fostering adherence can result in cost savings over time

Figure 17: Online patient support is positioned to become a key factor in treatment choice and persistence in several therapy areas requiring long-term treatment and caregiver support

Figure 18: AstraZeneca’s website, http://www.Seroquel.com, is notable for the variety of patient support tools it provides

Figure 19: AstraZeneca’s website, http://www.IsItBipolar.com, provides an international audience with information and resources related to bipolar disorder

Figure 20: Most patients are capable of some degree of self-management, but would still benefit from access to support services

Figure 21: Disease management interventions aimed to help caregivers have little impact on caregivers’ levels of depression or quality of life

Figure 22: Pharmaceutical companies should begin to consider approaches to drug adherence and disease management early in the lifecycle of a drug

Figure 23: The traditional paper-based prescribing process presents patients with many challenges to adherence and persistence

Figure 24: Eli Lilly’s HealthInsights for Women provides online resources for patients and healthcare professionals

Figure 25: GSK’s Adherence Starts with Knowledge (ASK) program focuses specifically on the importance of adherence to treatment in chronic disease

Figure 26: The pharmaceutical industry must take care to communicate with patients and caregivers in a way that increases their understanding of adherence

Figure 27: The unique design of PocketPak, which includes a fold-out instruction leaflet, allows for the inclusion of a large amount of information for patients