Datamonitor healthcare analyst and report author Adele Schulz says data from the Medicines Monitoring Unit (MEMO) at the University of Dundee in the UK 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-compliant.
This lies at the heart of the $30 billion (€24.9bn) annual cost to pharmaceutical companies from prescriptions and repeat prescriptions that are never filled. Meanwhile, patients also suffer in terms of loss of quality of life, while 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," according to Schulz.
She notes that unintentional 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.
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 behaviour.
For example, Novartis recently launched a patient recruitment programme for its blood pressure drug Diovan (valsartan), and Schulz holds this up as 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' promotion advertises access to the support programme as a key incentive to seek treatment with Diovan, she notes.
So what else can companies do to tackle the problem? They must first understand the patient and why the message to adhere to treatment is not getting through. This can be achieved through utilisation of analytical customer relationship management (CRM), she says.
However Datamonitor's 2004 Patient Compliance survey found that many companies are underutilising CRM. Of the 80 per cent of respondents that used CRM, only 25 per cent reported that this initiative was being used to address patient compliance through targeted marketing.
And 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 tend to be the hardest to reach, Schulz says.
"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 programmes and education, she adds.
Personalised patient communications and support may be the most effective marketing strategy when the aim is to boost patient compliance, but the cost of such a strategy is often seen as prohibitive.
But the report suggests that while DTPC programmes 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, Schulz says. For instance, 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.