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  • Link to KAM model and reduced resourcesHow many have patient centric activities within brand campaign plan?How many have an adherence strategy within their brand strategies?Do you think patient adherence programmes are a good investment? Yes, no, don’t knowThe link between PSP and adherence
  • £300m = £90m unused meds + £110m returned to pharmacy + £50m disposed of by care homes
  • Breast, cholesterol, ACS, overactive bladder, diabetes, osteoporosis, GERD, asthma, COPD
  • £162m lost revenue / year - what is it costing you?
  • Interventions – counselling, written information & personal phone callsLong-term – information, reminders, self monitoring, family therapy etc.Less than half the studies small in numbers and therefore not poweredself report
  • The Service Delivery and Organisation Network comprises a group of NHS organisations which supportresearch, evaluation and innovation to enable managers to improve and develop services.
  • - CHF- Personalisation is all about delivering info. that is specific to your beliefs
  • Modelled ROI forecasts based on the above outcomes within asthma for certain companies
  • “85% of GP’s more likely to prescribe a treatment with a PSP v’s one without when all other things considered equal”
  • Still going – 5 years on
  • Study based on 135,000This US based study to a financial approach to the issue of adherence and the its impact on subsequent healthcare costs using a return on investment approach. Essentially the study answers the following question. ‘For every additional dollars worth of medication ingested by a patient what is the impact on healthcare utilisation costs?’ Across all 4 disease reviewed all four came back with a positive return on investment for increasing adherence (and the subsequent higher investment in medicines). In CHF for every additional dollars worth of medicines taken by the patient there was an associated $8.40 saving in reuced health utilisation (reduced hospitalisation rates and length of time spent in hospital) emergency dept visits etc.
  • 97% needs to be replaced by 89% and the 3% needs to be replaced by 1%
  • Support & interventions must be targeted towards the intentional non–adherence issues (perceptions/health beliefs) and the non-intentional issues (practical barriers)Support programmes need to be personalised – tailored messages based upon patient behavioursSupport programmes can deliver commercial ROI but avoid the common pitfalls


  • 1. Patient support programmes within medicines optimisation – the pros and cons Andy Carter | Director of Strategy Atlantis Healthcare
  • 2. Patient Support Programmes within medicines optimisation “Good commercial value or bad investment” Andy Carter Director of Strategy, Atlantis Healthcare
  • 3. 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
  • 4. 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
  • 5. © 2013 Atlantis Healthcare | Commercial in Confidence Page 5 Medication optimisation is on the UK’s agenda Royal Pharmaceutical Society Medicines 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
  • 6. © 2013 Atlantis Healthcare | Commercial in Confidence Page 6 Pharma investment reacting to medicines optimisation agenda
  • 7. © 2013 Atlantis Healthcare | Commercial in Confidence Page 7 Non adherence transcends all conditions
  • 8. © 2013 Atlantis Healthcare | Commercial in Confidence Page 8 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
  • 9. © 2012 Atlantis Healthcare | Commercial in Confidence Page 9 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
  • 10. The evidence to date Patient adherence interventions / support
  • 11. 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
  • 12. © 2013 Atlantis Healthcare | Commercial in Confidence Page 12 A consistent weakness in research to date around adherence NHS – SDO CRITICAL REVIEW Horne, 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)
  • 13. © 2013 Atlantis Healthcare | Commercial in Confidence Page 13 Perceptions & health beliefs drive intentional non-adherence
  • 14. The impact of personalised interventions Product All preventer inhalers Programme name Asthma AIM Publication Published British Journal of Health Psychology
  • 15. 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
  • 16. Improved adherence in asthma intervention group Adherence% 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.
  • 17. Personalised programmes can deliver lasting behaviour change 0 10 20 30 40 50 60 70 Baseline 6 Weeks 12 Weeks 18 Weeks 6 Months 9 months Control Intervention Group AverageAdherence% 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.
  • 18. Patient support programmes with personalised interventions - Delivering positive ROI
  • 19. 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
  • 20. Patient support programme Patients 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 control 2. Create a patient support programme that is valued by patients and is recognised by HCP’s 3. Differentiate product from its competitors Atlantis Healthcare - Data on file Programme running for 5 years due to positive commercial return
  • 21. 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
  • 22. 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 investment Chronic heart failure 8.4 : 1 Hypertension 10.1 : 1 Diabetes 6.7 : 1 Dyslipidaemia 3.1 : 1
  • 23. Key learnings & recommendations
  • 24. © 2013 Atlantis Healthcare | Commercial in Confidence Page 24 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
  • 25. © 2013 Atlantis Healthcare | Commercial in Confidence Page 25 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 Adherence Solutions Marketing budget spend 89% v’s 10% v’s 1% On patient Payor On patient acquisition marketing retention
  • 26. © 2013 Atlantis Healthcare | Commercial in Confidence Page 26 Adherence strategies can deliver for ALL stakeholders Patients Do more, feel better, live longer Personalised solutions Pharma Improved sales from existing patients Improved market access Competitor differentiation Healthcare Improved outcomes Reduced wastage Lower healthcare utilisation