Transcript The First Annual PMRG Institute

1
EU DTCA Ban: Effect on Patient
Awareness & Influence on Prescribing
Carol Faverger
Director
2
Rosalyn Twite
Director
Context: Direct to Consumer Advertising in EU
Advertising non-prescription medicines
Generally allowed, but with restrictions
Advertising Prescription medicines
Prohibited as per The Advertising Regulations 1994, which implement EU
directive 92/28/EC
• Exceptions allow information on prescription only medicines (POMs) to
be provided to the public
e.g. reference materials (without product claims), human
health and disease related statements with no direct or
indirect reference to the product
3
Crystal Ball Questions
Given DTCA of POMS in EU is banned, have we under-estimated the role
of patients in prescribing decisions when conducting research?
Are patients being influenced by other means?
Are we reaching out to the correct decision makers when conducting our
research?
Has the DTCA ban really led to less-informed patients in EU than in the
USA?
In the future, should we be increasingly focusing on patients
as decision makers ?
4
Gauging the True Influencers: Method
KQH linked up with Research Now
PATIENTS
PHYSICIANS
USA, GERMANY, UK, ITALY,
USA, GERMANY, UK, ITALY,
FRANCE, SPAIN
FRANCE, SPAIN
Total n =3000
Total n=240
n=500 per country
n=40 per country
Must have been prescribed a drug
in the last 12 months
GPs / PCPs
Online survey - by Research Now Online survey - by Research Now
Conducted January 2008
Conducted January 2008
5
Are patients discussing / just accepting?
USA
GERMANY
U.K.
ITALY
FRANCE
SPAIN
Patient assumes drug is
the most suitable and
accepts without
Patient brings up
discussion
possible alternatives
Patient* Physician** Patient * Physician**
81%
18%
56%
47%
72%
82%
16%
30%
66%
85%
13%
31%
68%
84%
15%
36%
82%
80%
16%
20%
83%
88%
11%
21%
* 500 patients per country interviewed Jan '08
** 40 PCPs per country interviewed Jan '08
Other
Patient * Physician**
4%
1%
3%
6%
4%
2%
3%
2%
2%
1%
4%
1%
Findings
• Majority across all countries are accepting without discussion
•
Drs and patients agree that in over 80% of cases there will be
no discussion
•
Drs also state in over 80% of cases there is no
discussion BUT patient responses flag up a greater willingness to
mention alternatives (30 – 47%)
• EU patients self report as being more likely to accept without discussion
(74% EU average vs 56% US)
• Awareness of alternatives significantly higher
amongst US patients (47% vs 28% EU average)
7
If neither suggesting alternatives nor accepting
• Main concern was to learn more of side effects and efficacy
• Reluctant patients who are not keen on taking drugs
•
Like to confirm medication choice with a Specialist
•
Financial side mentioned
•
Patients discuss with Pharmacist
•
“Many patients have preconceived ideas about what product should
achieve which results”
•
Fear that physician will prescribe the cheapest
possible alternative
..
Patient Influencers
Patients: From which of the following will you be aware of possible alternative drugs
Physicians: Have patients referred to the following when discussing drugs with you
Drs only:
Educational
patients
Advertising
leaflets (eg
not
Articles in in papers /
leaflets in a A patient
Other
papers /
magazines
The
surgery /
support
(Please referred to
magazines
/on TV
internet
hospital)
group
specify) anything
6% 20%
USA
32%
70% 28% 78% 38% 70% 27% 25% 5% 10%
2%
GERMANY 18%
65% 10% 60% 24% 85% 13% 33% 3% 37%
8% 18%
2%
U.K.
ITALY
FRANCE
SPAIN
21%
23%
8%
12%
95%
78%
83%
50%
8%
11%
5%
5%
68%
85%
78%
63%
27%
26%
14%
15%
93%
58%
63%
68%
17%
20%
8%
11%
15%
10%
25%
13%
3% 40%
3% 5%
1% 8%
4% 10%
8%
6%
5%
6%
17%
5%
8%
18%
Patients - %age of total sample (asked only of those who may mention alternatives)
Physicians - %age of total sample
0%
7%
2%
13%
Findings
• Physician main sources: articles, internet & advertising
• Patient main sources: internet, articles & educational leaflets
• Advertising high in EU despite DTC Advertising ban?
• US patients self report that they use ALL
sources of info more than EU
• Physicians report higher use than patients
10
Other sources uncovered
•
18-20% of PCPs mentioned other
sources
• Patients & PCPs in all countries mentioned friends & family
as the main other source
•
Pharmacists
•
Patients consult with a specialist
•
Other patients
11
Patients actively searching for information on
drugs
Have you ever searched for information on drugs available for a condition
you may have:
On the
internet
Via
patient
support
groups
In the
media
USA
GERMANY
75%
72%
8%
7%
15%
22%
34%
21%
7%
8%
18%
21%
U.K.
ITALY
FRANCE
SPAIN
73%
69%
55%
61%
6%
6%
2%
5%
10%
17%
4%
11%
22%
34%
17%
27%
9%
6%
6%
10%
20%
18%
39%
27%
From
Other
educational (Please
leaflets
specify)
Asked of all n=500 patients per country, regardless of whether they discuss
None
Findings
• An average of 24% of patients across all countries have not
searched for information – very high in France (39%)
• Internet leads – average 66% across all countries
• Educational leaflets next most common - 26% average,
helped by high proportions in US and Italy (34%)
• Friends & Family – All
Specialists
Pharmacists
Other patients
Awareness of Pharma Cos / Associations
60%
55%
48%
50%
40%
40%
34%
33%
33%
30%
30%
25%
25%
24%
22%
20%
14%
10%
0%
USA
GERMANY
U.K.
Physicians
ITALY
Patients
FRANCE
SPAIN
Awareness of Pharma Companies
PATIENTS: Pharma Cos patients aware of that provide
information on drugs / diseases
Most
mentioned
2nd
3rd
USA
Merck
Pfizer
GSK
GERMANY
Bayer
Novartis
Roche
UK
GSK
Pfizer
Astra Zeneca
ITALY
Bayer
Roche
Pfizer
FRANCE
Sanofi Aventis
GSK
Bayer
SPAIN
Bayer
Pfizer
Novartis
PHYSICIANS: Pharma Cos who have been behind any of the
means of information referred to by patients
Most
mentioned
2nd
3rd
USA
Pfizer
Merck
Astra Zeneca
GERMANY
Hexal
Pfizer
Bayer
UK
Pfizer
GSK
Astra Zeneca
ITALY
Pfizer
Novartis
Menarini
FRANCE
Sanofi Aventis
Pfizer
GSK
SPAIN
Sanofi Aventis
Pfizer
Novartis
ALL
ALL
Bayer
GSK
Pfizer
Asked of all patients who were aware of Pharma Cos providing
information on drugs / diseases. (Total sample n=834)
Pfizer
Sanofi Aventis
GSK & Merck
Asked of all physicians who were aware of Pharma Cos being
behind any of the means of information referred to by patients
(Total sample n=86)
Is patient input growing?
USA
GERMANY
U.K.
ITALY
FRANCE
SPAIN
PATIENTS*: Are you more or less
likely to discuss different drug
choices with your doctor than you
were 5 years ago?
More
Less
The same
69%
2%
29%
68%
11%
21%
62%
1%
37%
44%
10%
46%
49%
3%
48%
45%
5%
50%
* 500 patients per country interviewed Jan '08
** 40 PCPs per country interviewed Jan '08
PHYSICIANS**: Do you think patients
are more or less likely to discuss
different drug choices with you than
they were 5 years ago?
More
Less
The same
75%
2%
23%
75%
2%
23%
93%
0%
7%
83%
0%
17%
76%
3%
21%
68%
2%
30%
Why patients are more likely to discuss different
drug choices – The Physician Viewpoint
• More information available
• But are they better informed?
• Doubts on validity of source of information
•
Searching for cheaper
alternatives
Why patients are more likely to discuss different
drug choices – The Patient Viewpoint
• More information available
• Drs seen as more approachable
•
Cost
• Increased concern about side effects
Drug most asked about in the last 12 months
Which one individual drug have patients asked the most about
in the last 12 months?
Most
mentioned
2nd
3rd
USA
Champix
Viagra
Cialis
GERMANY
Champix
Viagra
Simvastatin
UK
Champix
Simvastatin
Aulin
Viagra
Viagra
Limpidex
(lanzopraxole)
Champix
Viagra
Celebrex
Analgesics
Viagra
Cialis
ITALY
FRANCE
SPAIN
Asked of all n=40 physicians per country, Total n=240
Today
• Perceptions of Physicians and Patients vary
• EU DTCA ban less impact than expected?
• Patient apathy in France & Spain?
• Patients more likely to discuss alternative drug choices than 5 years ago
• Patients self-educating primarily using the internet, then
educational leaflets, then the media
• Side effects and cost driving patients search for information
Tomorrow – in the Crystal Ball …
• Patient use of support groups rises
• Greater collaboration between Physician and patient
• Increased focus in media on health related issues
• Patients more aware of cost considerations
• Increasing role of alternative medicine
• EU / USA awareness distinction narrows
For more information, please contact . . .
Carol Faverger
Director
+44 (0)20 8090 5547
[email protected]
22
Rosalyn Twite
Director
+44 (0)20 8090 5549
[email protected]