Patient compliance a $30bn complaint

We all forget to take medication from time to time, or maybe even don't bother to refill our prescriptions because we're feeling fine.

However, the cumulative effect of all this is costing the pharmaceutical industry in excess of $30bn a year. On top of that, it could be costing the healthcare system in increased consultations and treatment, and ultimately could be affecting patient health. However a new report by independent market analyst Datamonitor offers pharmaceutical companies some practical solutions to help stop the financial bleeding.

Datamonitor healthcare analyst and report author Adele Schulz says data from the Medicines Monitoring Unit (MEMO) at the University of Dundee indicates that only one third of patients are fully compliant with their drug prescriptions. A third are non-compliant while the remaining third are considered completely non-compliant¹.

'On top of the over $30bn annual cost to the pharmaceutical companies from prescriptions and repeat prescriptions never filled, patients also suffer in terms of loss of quality of life. Furthermore, National Health Services also incur costs due to the increased risk of hospitalisation and additional healthcare interventions.

'There are also other factors that are hard to quantify, yet have a significant impact on the industry, such as a loss of faith from physicians and patients when a particular medication is perceived to have been ineffective,' Schulz commented.

Unintentional non-compliance can easily be targeted through such simple solutions as electronic or telephone reminders to take medication or refill prescriptions, however intentional non-compliance is more difficult to address. Schulz said: 'The results of Datamonitor's patient compliance survey 2004 support the idea that tailored or personalised communication with patients is an important tool in compliance initiatives. In other words, the interaction with patients must not stop at direct-to-consumer advertising (DTCA) that raises awareness of products at product launch. Instead, direct-to-patient communication (DTPC) should be provided throughout the pharma-patient relationship to provide continual support to compliant behavior.'

Novartis's recently launched patient recruitment program for Diovan is an example of a DTCA awareness initiative that is fully integrated with a patient education and support service. The 'Take Action for a Healthy BP' (blood pressure) promotion advertises access to the support program as a key incentive to seek treatment with Diovan.

Finding drivers of non-compliance

In order to develop a tailored patient communications strategy, companies must first understand the patient and the drivers of his or her non-compliance. This can be achieved through utilisation of analytical customer relationship management (CRM), she says. 'However, our survey found that many companies are underutilising CRM. Of the 80% of respondents that used CRM, only 25% reported that this initiative was being used to address patient compliance through targeted marketing.' One of the biggest barriers hindering the return on investment of CRM programmes where patient compliance is the aim is the fact that the very patients most in need of such intervention may be the hardest to reach. Schulz comments: 'While patients with severe symptoms may appreciate the provision of patient support services such as a telephone helpline, Datamonitor's analysis indicates such patients are not at the greatest risk of non-compliance. Asymptomatic patients are more prone to low compliance due to the limited perceived benefit of a therapy.

'Such patients are unlikely to be sufficiently motivated about their disorder to make use of telephone helplines or online educational content. Likewise, non-compliance in patients with a distrust of pharmaceuticals and the pharmaceutical industry will not be effectively addressed through the provision of company sponsored support programs and education.'

Costs too high?

While personalised patient communications and support may be the most effective marketing strategy when the aim is to boost patient compliance, the cost of such a strategy is often seen as prohibitive. But while DTPC programs are more resource intensive than DTCA and branding, the smaller target audience can reduce the overall costs of this strategy. Also the increased access of the general public to electronic communications is further reducing the cost of DTPC campaigns, making it more applicable to a wider range of disorders.

When evaluating the cost effectiveness of patient compliance initiatives, companies should tailor their strategies and consider the per patient cost of the intervention. In large therapeutic indications, where the value of each patient to the pharmaceutical company is low, costly DTPC campaigns may not be appropriate. Meanwhile, in niche disorders where the value per patient is high, DTPC not only represents a more effective way of targeting compliance but may also represent a more cost-effective option than mass-market DTCA approaches.