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© Matrix45, All rights reserved.www.matrix45.com enhancing one-on-one physician communications through the use of evidence-based e 2 marketing ivo abraham center for business intelligence emarketing for the pharmaceutical industry philadelphia, 17 march 2005 MATRIX Frays Ridge Road Earlysville, VA – USA Offices in US and Europe
© Matrix45, All rights reserved.www.matrix45.com 1 overview concept of e 2 -marketing concept of e 2 -marketing penetration and adoption of best practice guidelines penetration and adoption of best practice guidelines knowledge clinical behavior change? knowledge clinical behavior change? macro vs. micro evidence micro-trialing
© Matrix45, All rights reserved.www.matrix45.com 2 overview case study case study management of mild asthma in primary care » drivers » analysis » solution benefits benefits
© Matrix45, All rights reserved.www.matrix45.com 3 e 2 -marketing defining the concept electronic electronic and and evidence-based capitalizing on the power of the internet harnessing the value of evidence-bases for clinical practice stimulating stimulating clinician behavior change change in complex clinical areas through data- driven, value-added support services services … and to so improve improve sales, patient outcomes, clinician competence, and economics of care.
© Matrix45, All rights reserved.www.matrix45.com 4 e 2 -marketing process building and maintaining physicians clinical confidence in product-centric treatment solutions building and maintaining physicians clinical confidence in product-centric treatment solutions product » therapy » treatment solution knowledge-based relationship pharma ~ physician tryout trials + outcomes-focused feedback reinforcement + renewal
© Matrix45, All rights reserved.www.matrix45.com 5 e 2 -marketing value proposition clinical confidence clinical behavior change product adoption market position sales ripple effects treatment solutions, loyalty, cross-over, …
© Matrix45, All rights reserved.www.matrix45.com 6 evidence-based practice ideal vs. real-world meta-analyses randomized controlled trials quasi-experimental studies cohort / observational studies case-control studies cross-sectional studies clinical cases expert opinion RCTs quasi- experimental meta- analyses case- control cohort- observational cross- sectional clinical cases (expert) opinion
© Matrix45, All rights reserved.www.matrix45.com 7 two approaches (Eddy, Health Affairs 2005) two approaches (Eddy, Health Affairs 2005) evidence-based guidelines evidence-based individual decision-making (re-)definition (re-)definition a set of principles and methods intended to ensure that to the greatest extent possible, medical decisions, guidelines, and other types of policies are based on and consistent with good evidence of effectiveness and benefit (Eddy, Health Aff 2005) evidence-based practice defining the concept(s )
© Matrix45, All rights reserved.www.matrix45.com 8 >1000 guidelines created annually >1000 guidelines created annually (Jackson & Feder, BMJ, 1998; Rosser et al., J Fam Practice, 2001) few guidelines lead to consistent changes in provider behavior few guidelines lead to consistent changes in provider behavior (Cabana et al., JAMA 1999; Grol, Med Care, 2002; Timmermans & Mauck, Health Aff 2005) asthma (Goodman et al., Pediatrics 1999; Johnson et al., Pediatrics 2000; Crim, Chest, 2000; Lagerlof et al., Eur Resp J, 2000) beyond asthma: mean adherence rate of 54.5% (Burstin et al., Am J Med, 1999) – probability ~ 50% (Med Care, 1994) evidence-based practice knowledge clinical behavior change?
© Matrix45, All rights reserved.www.matrix45.com 9 asthma: the ideal disease (Timmermans & Mauck, Health Aff 2005) asthma: the ideal disease (Timmermans & Mauck, Health Aff 2005) serious public health concern » most common chronic illness of early childhood » rising incidence » USA: 5000 deaths/year, hospital admissions/year, 13.7 ambulatory care visits/patient ample guidelines available and among the best known of pediatric guidelines (Flores et al., Pediatrics, 2000) evidence-based practice knowledge clinical behavior change?
© Matrix45, All rights reserved.www.matrix45.com 10 asthma: the reality asthma: the reality adoption of guidelines » mixed and disappointing (Timmermans & Mauck, Health Aff, 2005; Stoloff, Am J Managed Care, 2000) knowledge about versus following guidelines » US pediatricians: 88% familiar yet 35% followed guidelines (Flores et al, Pediatrics, 2000) » hospital-wide implementation: 68% adherence (Smeele et al, Qual in Health Care, 1999) evidence-based practice knowledge clinical behavior change?
© Matrix45, All rights reserved.www.matrix45.com 11 evidence-based practice more real world examples hypertension hypertension real world practice trial evidence and best practice guidelines (JNC7, ESC, …) » diagnosis (diabetes / nondiabetes) » targets » treatment options and adjustments » risk factors for cardiovascular events » patient outcomes
© Matrix45, All rights reserved.www.matrix45.com 12 evidence-based practice more real world examples anemia management in dialysis patients anemia management in dialysis patients real world practice trial evidence, observational studies findings, and best practice guidelines severe sepsis / septic shock (Xigris®) severe sepsis / septic shock (Xigris®) accelerated approval » commercial failure uncertain area ~ low clinician confidence evidence-base of 1 with hypothesized MOA unlinking product and clinical process
© Matrix45, All rights reserved.www.matrix45.com 13 evidence-based practice the blind adoption problem randomized controlled trials as the only parameter of evidence randomized controlled trials as the only parameter of evidence if the wise (wo)men say so, i shall do so if the wise (wo)men say so, i shall do so de-skilling of clinicians – cookbook care de-skilling of clinicians – cookbook care misunderstanding ethics, feasibility, and knowledge development issues misunderstanding ethics, feasibility, and knowledge development issues
© Matrix45, All rights reserved.www.matrix45.com 14 macro-evidence macro-evidence evidence from studies + meta- analyses formal learning micro-evidence evidence from one's own clinical experience and experimentation application in ones own practice evidence-based practice macro- vs. micro-evidence
© Matrix45, All rights reserved.www.matrix45.com 15 macro-evidence macro-evidence seeing the larger picture – many- other-patients – what-patients- should-be-like mega-knowledge micro-evidence seeing with one's own eyes" - the "my-patients" picture micro-trialing evidence-based practice macro- vs. micro-evidence
© Matrix45, All rights reserved.www.matrix45.com 16 micro-trialing knowledge » confidence » behavior anecdote anecdote rep has been here several times now im reading and hearing more about that product, maybe I should try it out let me try it on my next ten patients and well see physician focus on systematically trying the product but unsystematically examining patient outcomes physician focus on systematically trying the product but unsystematically examining patient outcomes
© Matrix45, All rights reserved.www.matrix45.com 17 micro-trialing knowledge » confidence » behavior supporting physicians in supporting physicians in exploring and adopting new treatments changing personal practices and standards of care going against established practices (from known to innovation) expanding if not changing their clinical comfort zone
© Matrix45, All rights reserved.www.matrix45.com 18 case-study background background asthma: incidence = global market treatment options for asthma are driven by severity and persistence » inhaled corticosteroids$ 2.76 B » beta-2 antagonists$ 3.74 B » leukotriene anatgonists$ 2.12 B » combinations$ 3.10 B $ 11.7B 2003 global sales; Morgan Stanley, 2004
© Matrix45, All rights reserved.www.matrix45.com 19 case-study background: market share of LTRA in USA vs. Europe/Japan by patient class background: market share of LTRA in USA vs. Europe/Japan by patient class LTRA market leader in USA, ICS in ROW
© Matrix45, All rights reserved.www.matrix45.com 20 case-study background: evidence-base background: evidence-base best practice guidelines in usa & europe » step-up step-down approach » inhaled corticosteroids (ICS) most effective anti- inflammatory agent to control asthma » LTRA class recommended as may be considered for mild persistent asthma as place in therapy is not fully established » importance of steroid-sparing therapy
© Matrix45, All rights reserved.www.matrix45.com 21 case-study background: evidence-base (contd) background: evidence-base (contd) best practice guidelines: canada » ICS as first line therapy » LTRA recommended as alternative therapy » deep dissemination and penetration role of biopharma companies with vested interests blind adoption trend in primary care evidence related to LTRA continues to accumulate
© Matrix45, All rights reserved.www.matrix45.com 22 analysis innovation best practice guidelines: geographical boundaries in a global medical community disseminating to a nonspecialist, (relatively) research-naïve physician population positioning at the interface of marketing and medical affairs conventional sales strategies and tactics: necessary but not sufficient change pharma- to physician relationship information transfer knowledge- based value-added in line with physician values
© Matrix45, All rights reserved.www.matrix45.com 23 analysis physicians getting out of clinical comfort zone gain and maintain confidence in product & therapy: knowledge experience outcomes and risk management frame-work market investment market strength evidence-based (e)Learning postmarketing study fatigue: perceived return beyond just money value-added services e 2 -marketing electronic and evidence-based growing demand specialty care primary care competitive advantage beyond e-gimmicks
© Matrix45, All rights reserved.www.matrix45.com 24 case-study objectives objectives create an evidence-based platform for effecting clinical behavior change in primary care physicians in the management of asthma increase experience base of clinicians in managing asthma with through micro-trialing » systematic data framework » feedback to examine outcomes in their patients » technology-enabled
© Matrix45, All rights reserved.www.matrix45.com 25 case-study objectives (contd) objectives (contd) improve and maintain physician confidence in target therapy increase persistent product adoption strengthen market position increase market share and sales
© Matrix45, All rights reserved.www.matrix45.com 26 Risk Screening Risk Management Clinical Support Clinical Patient Level Clinical Practice Level Evidence-Based Benchmarks case-study framework
© Matrix45, All rights reserved.www.matrix45.com 27 case-study process large cohort participating physicians / centers retrospective chart audit conversion decision per physician best judgment new patients start decision per physician best judgment longitudinal data collection on Rx and patient outcomes data transmission feedback reports to physicians: patient X my patients all patients benchmarks
© Matrix45, All rights reserved.www.matrix45.com 28 case-study flowchart analytical database entry of patient data MD web-based e-reports analyses patient X my patients my pts vs. all pts my pts vs. benchmarks 1:1 pharma to physician plan-driven and ad hoc analyses on aggregate sample dissemination pharma databases pharma
© Matrix45, All rights reserved.www.matrix45.com 29 e 2 -marketing benefits to physicians research participation new model of research participation micro-trialing contribution to larger study bridging the chasm efficacy effectiveness safety monitoring new relationship with pharma one-on-one knowledge-based on exchange basis: data value-added services in return in line with values experience, confidence, clinician decision-making, patient outcomes
© Matrix45, All rights reserved.www.matrix45.com 30 e 2 -marketing benefits to pharma integrated approach physician-focused support accumulating real-world effectiveness data databases on practice patterns and outcomes safety monitoring conventional scientific productivity is enhanced one-on-one physician relationship knowledge exchange information transfer aligned with current thinking in medicine overcomes limitations of and reframes evidence-based practice interface with (e-)detailing
© Matrix45, All rights reserved.www.matrix45.com 31 e 2 -marketing benefits to pharma efficiency large coverage at minimal incremental cost coordination marketing ~ medical affairs pays for itself through ongoing product sales and ripple effect effectiveness data on practice patterns and outcomes support strategy extended pharmaco-vigilance market position: what is the effect on sales?
© Matrix45, All rights reserved.www.matrix45.com 32 global expansion of survey ( ) within and across indications ~ worldwide sales growth from $1.5 billion (1998) to $4.2 billion (2002) implementation of 6-month longitudinal study state-of-the-art symposium e 2 -marketing impact on sales % change in sales of blockbuster in western europe
© Matrix45, All rights reserved.www.matrix45.com 33 e 2 -marketing revisited & summarized e-marketing e 2 -marketing e-marketing e 2 -marketing electronic and evidence-based to effect clinical behavior change product adoption market position sales ripple effects
© Matrix45, All rights reserved.www.matrix45.com 34 e 2 -marketing revisited & summarized challenges of adopting best practice guidelines challenges of adopting best practice guidelines micro-evidence micro-trialing model and service of evidence-based support model and service of evidence-based support asthma extendable to other diseases and drugs
© Matrix45, All rights reserved.www.matrix45.com 35 e 2 -marketing revisited & summarized the value of value-added services the value of value-added services benefits benefits physicians biopharmaceutical companies impact on patient care? impact on patient care? To download this presentation, please go to the News section at
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