1. Dysport - MB - November 2007
Innehåll
1 Sammanfattning och rekommendationer till ledningen Projektbeskrivning Resultatanalys

2. Dysport MB - in adult spasticity, secondary to stroke and juvenile cerebral palsy
Kungsbacka in November 2007
SIFO Research International Navigare

3. Background and Objectives
Dysport - MB - November 2007
Background and Objectives
In Sweden, unlike the rest of Europe Botox is the market leader among Botulinum toxins with approx 90-95% market share. This market description study is conducted in order to evaluate the Swedish market of botulinum toxins and find the attitudes towards Botox vs Dysport. Other important issues are prescription habits, who takes the decisions regarding the choice of Btx and to find out what is required to switch Botox for Dysport.   
Method
The interviews were carried out during October and November 2007 and were performed as pre-arranged telephone interviews with 24 specialists. The interviews took approximately minutes and were performed by medically trained interviewers.
AS a member of ESOMAR (European Society for Opinion and Market Research) Navigare follows the ethical rules for marketing research. Among other things these rules mean that the respondents are guaranteed full anonymity.

4. Patient Flow and Frequencies
Dysport - MB - November 2007
Patient Flow and Frequencies

5. Dysport - MB - November 2007
Source: QXa Base: All Drs

6. Dysport - MB - November 2007
Source: Q1a Base: All Drs

7. Dysport - MB - November 2007
Source: Q1aa Base: All Drs

8. Dysport - MB - November 2007
Source: Q1b Base: All Drs

9. Dysport - MB - November 2007
Source: Q2 Base: All Drs

10. Choice of Treatment - Initiation
Dysport - MB - November 2007
Choice of Treatment - Initiation
Initiation of Adult Spasticity and Juvenile Cerebral Palsy
- Share of Patients Treated with Botulinum Toxins 11 22 17 39 33 5 10 15 20 25 30 35 40 45 50
none
1-20
21-40
41-60
61-80
81-100
don't know
adult spasticity (n=18)
juvenile cerebral palsy (n=9)
% Drs
adult
spasticity
(n=18)
juvenile
cerebral palsy
(n=9)
mean
51,7
56,9
median
50,0
min
0,0
33,0
max
100,0
Source: Q3a Base: All Drs

11. Initiation of Adult Spasticity and Juvenile Cerebral Palsy
Dysport - MB - November 2007
Initiation of Adult Spasticity and Juvenile Cerebral Palsy
- Treatment Alternatives to Botulinum Toxins 89 67 22 17 6 44 11 33 10 20 30 40 50 60 70 80 90
100
physiotherapy
baclofen
diazepam
gabapentin
surgery
other
adult spasticity (n=18)
juvenile cerebral palsy (n=9)
% Drs
Source: Q3b+4b Base: All Drs

12. Dysport - MB - November 2007
Source: Q3c+4c Base: All Drs

13. Dysport - MB - November 2007
Source: Q3c+4c Base: All Drs

14. Dysport - MB - November 2007
Source: Q3d+4d Base: All Drs

15. Dysport - MB - November 2007
Source: Q3d Base: All Drs

16. Dysport - MB - November 2007
Source: Q4d Base: All Drs

17. Dysport - MB - November 2007
Source: Q5 Base: All Drs

18. Dysport - MB - November 2007
Source: Q5 Base: All Drs

19. Dysport - MB - November 2007
Source: Q5 Base: All Drs

20. Dysport - MB - November 2007
Source: Q6a Base: All Drs

21. Dysport - MB - November 2007
Source: Q6a Base: All Drs

22. Dysport - MB - November 2007
Source: Q6b Base: All Drs

23. Dysport - MB - November 2007
Source: Q6b Base: All Drs

24. Dysport - MB - November 2007
Source: Q6b Base: All Drs

25. Adult Spasticity Dysport - MB - November 2007
Source: Q7a Base: Adult spasticity

26. Dysport - MB - November 2007
Source: Q7b Base: Adult spasticity

27. Dysport - MB - November 2007
Source: Q8 Base: All Drs

28. Switch Treatment Dysport - MB - November 2007
Source: Q9a Base: All Drs

29. * Note low number of respondents
Dysport - MB - November 2007 * *
* Note low number of respondents
adult
spasticity
(n=9)
juvenile
cerebral palsy
(n=3)
mean
4,6
13,3
median
0,0
10,0
min
max
30,0
Source: Q9b Base: Drs who switched treatment

30. Dysport - MB - November 2007
Source: Q9c+d+e Base: Drs who switched treatment

31. Dysport - MB - November 2007
Source: Q9f Base: All Drs

32. Dysport - MB - November 2007
Source: Q9g+h Base: Drs who switched treatment

33. Dysport - MB - November 2007
Source: Q10a Base: All Drs

34. Opinion About Botulinum Toxins
Dysport - MB - November 2007
Opinion About Botulinum Toxins
Source: Q11 Base: All Drs

35. Dysport - MB - November 2007
Source: Q12a Base: All Drs

36. Dysport - MB - November 2007
Source: Q12a Base: All Drs

37. Dysport - MB - November 2007
Source: Q12a Base: All Drs

38. Dysport - MB - November 2007
Source: Q12b Base: All Drs

39. Dysport - MB - November 2007
Source: Q13a Base: All Drs

40. Dysport - MB - November 2007
Source: Q13b Base: All Drs

41. Dysport - MB - November 2007
Source: Q13b Base: All Drs

42. Dysport - MB - November 2007
Source: Q13b Base: All Drs

43. Dysport - MB - November 2007
Source: Q14a Base: All Drs

44. Dysport - MB - November 2007
Source: Q14a Base: All Drs

45. Dysport - MB - November 2007
Source: Q14a Base: All Drs

46. Dysport - MB - November 2007
Source: Q15a Base: All Drs

47. Dysport - MB - November 2007
Source: Q15a Base: All Drs

48. Dysport - MB - November 2007
Source: Q15a Base: All Drs

49. Dysport - MB - November 2007
Source: Q15b Base: All Drs

50. Dysport - MB - November 2007
Source: Q15b Base: All Drs

51. Dysport - MB - November 2007
Source: Q15b Base: All Drs

52. adult spasticity (n=18) juvenile cerebral palsy (n=9) mean 3,1 3,3
Dysport - MB - November 2007
adult
spasticity
(n=18)
juvenile
cerebral palsy
(n=9)
mean
3,1
3,3
median
3,0
min
1,0
max
5,0
Source: Q16a Base: All Drs

53. Dysport - MB - November 2007
Source: Q16b Base: All Drs

54. Dysport - MB - November 2007
Source: Q16b Base: All Drs

55. Dysport - MB - November 2007
Source: Q17a Base: All Drs

56. Dysport - MB - November 2007
Source: Q17b Base: Drs who prescribe “off-label”

57. Dysport - MB - November 2007
Source: Q18a+c Base: All Drs

58. Dysport - MB - November 2007
Source: Q18b Base: All Drs

59. Dysport - MB - November 2007
Source: Q18d Base: All Drs

60. Dysport - MB - November 2007
Company
Source: Q19a Base: All Drs

61. Dysport - MB - November 2007
Source: Q19b Base: All Drs

62. Dysport - MB - November 2007
Source: Q19c Base: All Drs

63. Dysport - MB - November 2007
Source: Q19c Base: All Drs

64. Dysport - MB - November 2007
Source: Q19c Base: All Drs

65. Dysport - MB - November 2007
Source: Q19c Base: All Drs

66. Dysport - MB - November 2007
Source: Q19c Base: All Drs

67. Dysport - MB - November 2007
Source: Q19c Base: All Drs

68. Dysport - MB - November 2007
Source: Q19d Base: All Drs

69. Dysport - MB - November 2007
Source: Q19d Base: All Drs

70. Dysport - MB - November 2007
Source: Q19d Base: All Drs

71. Dysport - MB - November 2007
Source: Q19d Base: All Drs

72. Dysport - MB - November 2007
Source: Q19d Base: All Drs

73. Dysport - MB - November 2007
Source: Q19d Base: All Drs

74. Summary Patient flows and frequencies
Dysport - MB - November 2007
Summary
Patient flows and frequencies
1 Specialist involved in the care of patients with adult spasticity (AS) are, median figure, responsible for 40 patients and specialist in care of pats with juvenile cerebral palsy (JCP) are in care of 60 patients. Total amount of pats on Btx are for AS-drs 50 and 150 for JCP-drs. Drs in care of AS have 8 new patients per month and drs in care of pats with JCP have 2 new pats. Drs in care of JCP pats named possible Btx treatment for 90% of their patients and AS drs named possible treatment for 30% of their patients (median figures). (p 5-9)
Choice of treatment – Initiation
2 Share of patients initiated with Btx is 50% for both specialist groups (median figure). (p 10)
3 A great majority, approx 90% of AS- and JCP- drs mention that in initiation treatment they use physiotherapy. 67% of AS-drs named that they use baclofen and specialists in care of JCP-pats use baclofen to 44% of their patients. (n=11)
4 When asked for allocation of treatment approx 100 % of both patient groups are treated with physiotherapy. (p 12)
5 Drs initiate with Btx mainly to increase patients’ function and when insufficient efficacy of physiotherapy/baclofen. 22% of JCP drs use Btx as soon as possible. (p 14)

75. Summary Choice of treatment – Initiation
Dysport - MB - November 2007
Summary
Choice of treatment – Initiation
6 Four out of nine drs in care of JCP patients mentioned insufficient efficacy as the main reason for patients not receiving treatment with Btx. Drs in care of AS-patients named limited personnel resources and price. Note that 5 AS-drs and 3 JCP-drs named that all pats receive treatment with Btx. (p17)
7 98 % of new AS patients and 96% of JCP patients receive Botox. Only 2% of new AS-patients and 4% JCP patients receive Dysport. (p 20)
8 Main reason for choosing Botox more often than Dysport is experience/tradition/habit, mentioned by 67% of AS-drs and 78% of JCP drs.
Adult spasticity secondary to stroke
9 In median figure, patients with adult spasticity receive treatment with Btx after one year. The median age of that patient is 59 years. (p 25-26)
Present treatment with Botulinum toxins
10 A great majority of patients with AS and JCP are treated with Botox 96% vs 93%. 4% of AS-pats and 7% of JCP are treated with Dysport. Xiomin is also named. (p 27)

76. Summary Switch treatment
Dysport - MB - November 2007
Summary
Switch treatment
11 Half of the drs in care of AS patients mentioned that they have switched treatment from one Btx to another Btx. 1/3 of drs in care of AS patients have switch treatment, (p 28). In average 5 AS patients are switched from one Btx to another while drs in care of JCP pats mentioned 13 pats. Dysport is mainly switched in. (p 29)
12 When drs have switched from Btx, in this case Botox, to other treatment it has mainly been due to insufficient efficacy. Mainly switched in treatments are baclofen, surgery and physyotherapy. (p 31-32)
13. People who influence the choice of Btx are primarily drs but also physiotherapists in a lower extent. (p 33)
Opinion of Botulinum toxins
14. A majority of the drs do not have any opinion or seem that the products are equal. 17% of AS drs and 22% of JCP drs perceive Botox as more effective. 1 AS dr perceive Dysport as more effective. (p 34)
15. The main perceived advantages of Botox are experience, administration and the company’s education/service. The main advantage of Dysport is price. Note that half of the drs mentioned that they do not know Dysport’s advantage. (p 35-38)

77. Summary Switch treatment
Dysport - MB - November 2007
Summary
Switch treatment
16. Price is named as the main disadvantage with Botox compared to Dysport, mentioned by 50% of AS drs and 44% of drs in care of JCP patients. Half of the AS drs named administration as Dysport’s main disadvantage followed by lack of experience and diffusion. 44% of the drs in care of JCP patients mentioned lack of exp and 33% administration. (p 39-42)
17. AS drs: Patients mainly treated with Botox are those with spasticity (sec to stroke), dystonia and MS patients. JCP drs mentioned patients with JCP, children with spasticity and pats with moving toes. (p 43-45)
Dysport
18. Both groups of drs mentioned price and insufficient efficacy as possible reasons to switch from Botox to Dysport. Information is also named by JCP drs. (p 46-48)
19. Considerable differences in drs’ answers about dosage proportion. (p 49)
20 Median figure 3 for importance evaluation about Dysport’s lower price, 28 % of AS drs vs 44% of JCP say that it is very important (p 52)
21 Doctors do not see ay reason for prescribe or increase prescription of Dysport. (p 57) Information and education are the factors demanded to influence prescription of Dysport. (p 58)

78. Leverage of Dysport efficacy (product group /Dysport is the best)
Dysport - MB - November 2007
Key Findings
Retain
Low Price
Aim to
Leverage of Dysport efficacy (product group /Dysport is the best)
Leverage of Education, support and service
Leverage of pedagogical dosage schedule
Increase awareness of low risk for diffussion and antibody formation
Increase knowledge about Dysport – reps
Increase of emotional dimensions
Work with physiotherapists and clinical chiefs/buyers. Payers?
Positioning ?
Messages
Dysport effective Btx
mild side effects
easy administration?

79. Dysport - MB - November 2007
Innehåll
1 Sammanfattning och rekommendationer till ledningen Projektbeskrivning Resultatanalys