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Kelvin Stott PhD
Pharma R&D Portfolio Strategy, Risk & Decision Consultant

October 2012


                                                        ©KelvinStott2012
This presentation explores some of the underlying issues
responsible for declining pharma R&D productivity, and
provides a new, fully integrated approach to reverse this
trend by navigating R&D projects and portfolios through
the risk-return landscape in real time

A case study demonstrates how this system can be used
in practice to improve the risk-return profile of a Phase 2
development project according to risk appetite

This presentation focuses on R&D in the pharmaceutical
industry, however the approach can be used to manage
and optimize the risk-return profile of any business asset
at any stage of its lifecycle, at any level, in any industry

                                                     ©KelvinStott2012
Pharma R&D productivity crisis
Fundamental issues & insights
   Pharma industry challenges
   Top 10 organizational issues
Key elements of a complete solution
A new fully integrated approach
   Concept
   Process
Case study: Phase 2 project
Conclusion & key messages
                                      ©KelvinStott2012
Pharma R&D productivity crisis
Fundamental issues & insights
   Pharma industry challenges
   Top 10 organizational issues
Key elements of a complete solution
A new fully integrated approach
   Concept
   Process
Case study: Phase 2 project
Conclusion & key messages
                                      ©KelvinStott2012
New technologies have done
                                    nothing to slow the steady
                                   decline in R&D productivity


            Note the
            log scale!




Source: Bernstein Research, 2010
                                                                 ©KelvinStott2012
©KelvinStott2012
% of preclinical drug candidates successfully passing through each phase
35%

30%

25%
                                                                                 Preclinical
20%
                                                                                 Phase I

15%                                                                              Phase II
                                                                                 Phase III
10%                                                                              Approval

5%

0%
            1990-94           1995-99          2000-04           2005-09

                                                                                  ©KelvinStott2012
More money, capital
… people, FTEs
… skills, know-how
… data, information
… tools, technologies
… disease targets
… projects, partners


  So why is Pharma R&D productivity declining so rapidly?

                                                       ©KelvinStott2012
Pharma R&D productivity crisis
Fundamental issues & insights
   Pharma industry challenges
   Top 10 organizational issues
Key elements of a complete solution
A new fully integrated approach
   Concept
   Process
Case study: Phase 2 project
Conclusion & key messages
                                      ©KelvinStott2012
• Tighter regulations
                                                 Decreasing
                    • Low reimbursement
                                                   market
                    • Pricing pressures
                                                  potential


• Increasing R&D         Diminishing           • Patent expiries
  timelines (time       profit window          • Generics and
  to market)             (Value/ROI)             biosimilars

  Decreasing
     R&D            • Increasing R&D costs
  productivity      • Higher attrition rates

                                                          ©KelvinStott2012
Decreasing
Technical      quality of new
                                 Decreasing
                drug leads
                                success rates

                 Increasing
Commercial                       Increasing     Decreasing
                 standards
& regulatory                    costs/project   productivity
                   of care

                                 Increasing
                Decreasing
                                  timelines
Operational    organizational
               effectiveness




                                                      ©KelvinStott2012
Technical accessibility




                          Potential market by indication
                                                           ©KelvinStott2012
Technical accessibility




                          Potential market by indication
                                                           ©KelvinStott2012
Technical accessibility




                          Potential market by indication
                                                           ©KelvinStott2012
Current drugs have already exploited the most obvious leads
with the lowest risk and greatest potential
    Small molecules based on known active natural
    products, ligands, substrates, dietary ingredients & traditional
    medicines
    Recombinant blood-based proteins to treat deficiencies in simple
    metabolic & genetic diseases (e.g., insulin, GH, factor VIII)
    Vaccines and antibodies against major pathogens, toxic proteins

Remaining opportunities are technically more challenging or
have limited commercial potential
    Highly complex diseases with no clear mechanism, target or lead
    Tissue-based diseases with significant barriers to drug delivery
    Rare diseases and sub-types with existing drugs or limited market

Consequently, cost and risk have increased, like drilling for oil
from less abundant, less accessible, lower quality sources
                                                             ©KelvinStott2012
Increasing competition
   More safe and effective drugs have become available, raising the
   standard to compete for market share
   Generic competition is adding further pressure on drug prices

Improving regulatory standards
   Regulatory standards are continuously evolving to ensure patient
   welfare over current treatments with longer more costly trials, as
   regulators learn to avoid past issues (e.g., safety recalls)

Increasing strain on healthcare budgets
   Soaring healthcare costs are now considered unsustainable while
   payers & providers are under increasing pressure to reduce costs

Consequently, there has been increasing pressure to develop
more safe and effective drugs at lower cost
                                                             ©KelvinStott2012
Increasing technical risk (innovation)

Revolutionary          Incremental                         Generics &
                                         Combination
 first-in-class       improvements                        biosimilars:
                                        therapies and
  treatments             of existing                     exact copies of
                                          improved
based on new          drugs based on                     existing drugs
                                       formulations of
 & unproven             established                      competing on
                                        existing drugs
 target/MoA             target/MoA                         price only


            Increasing commercial risk (competition)


Regardless of strategy, overall risk is increasing with time

                                                                    ©KelvinStott2012
Pharma R&D productivity crisis
Fundamental issues & insights
   Pharma industry challenges
   Top 10 organizational issues
Key elements of a complete solution
A new fully integrated approach
   Concept
   Process
Case study: Phase 2 project
Conclusion & key messages
                                      ©KelvinStott2012
1. Too many ambiguous, conflicting goals
2. Misaligned performance metrics
3. Objective bias and illusion of control
4. Fundamental misunderstanding of risk
5. Left brain vs right brain mindset
6. Over-reliance on tools and processes
7. Managing information in silos
8. Ignoring key sources of information
9. Over-modeling discrete scenarios
10. Risk-averse culture and leadership
                                            ©KelvinStott2012
Get new products to market
Meet customer needs
Maximize sales/profit/value/ROI/…
Minimize/manage risk
Maximize probability of success
Optimize time, cost, quality
Do the right projects, do them right
Support the strategy
Manage resources effectively
                                       ©KelvinStott2012
What are the “right” projects/products?
Which customers? How to balance their needs?
What to maximize: sales, profit, value, ROI?
At what risk? What is “risk”?
How to define & measure success, quality, etc.?
If our goal is to support the strategy, what is the
goal of the strategy? Tail wagging the dog?
How flexible is the current plan/budget?
How to prioritize when goals are not aligned?
                                             ©KelvinStott2012
Measured performance               Shareholder interests

       Balanced
       scorecard

            No.
                              ≠   Project
                                             Portfolio
                                            Value ± RISK

                                               Project     Project
approvals/milestones, time,        Value        Value       Value
    cost, “quality”, etc.         ± RISK       ± RISK      ± RISK




                                                             ©KelvinStott2012
Performance metrics are over-simplified and do
not incorporate all key value/risk drivers
Often based on quantity and defined by simple
short-term operational milestones, e.g.,
   No. of approvals/successful phase transitions
   No. of milestones achieved on time/budget
Quality is judged subjectively, or measured only
in part, e.g., strategic fit, probability of success
Overall performance is calculated as weighted
average, does not correlate with value and risk
                                                   ©KelvinStott2012
Value/ROI
                                    ± RISK


                    Sales, P&L, cash flow forecasts ± RISK

 Technical &
                 Operational     Commercial            BD&L           Financial
  regulatory
PoS by phase     R&D costs       Target patients   Licensing fees   Discount rate
Prob. approval   R&D timelines   Market share      Dev. m’stones    DSI, DSO, DPO
                 Launch date     Adoption rate     Sales m’stones   Exchange rates
                 Capex           Dose & compl.     Royalty rates    Inflation rates
                 COGS            Net price                          Tax rates
                 S&M costs       New entrants
                 G&A costs       Generic entry
                                 Other factors
                                                                            ©KelvinStott2012
Perception                       Reality

                               Drug has intrinsic
     Positive bias
                              potential to succeed
(“get drug to market”)
                               (safe & effective)



                          ≠           ?
                               Drug is inherently
    Negative bias
                              unsafe, ineffective or
(“kill projects early”)
                                 uncompetitive




                                                       ©KelvinStott2012
Probability
of success    Biased objective
                 to succeed


                                     Costly late-
 Perceived                          stage failure
 potential
                    Unbiased
                    research
                                 Excess costs saved
                                 for other projects

 Intrinsic
 potential

                  Development Time & Cost
                                                      ©KelvinStott2012
Intrinsic
 potential

                              Unbiased
                              research
 Perceived
 potential
               Biased objective
              to kill project early
Probability
of success                               Opportunity
                                            cost


              Development Time & Cost
                                                  ©KelvinStott2012
Naturally, project teams want their projects to succeed, and set their
goals to develop a superior drug that is both safe and effective.
However, many seem to forget that the potential of a drug to be safe
and effective is an intrinsic property of the molecule which is already
built into the drug when it comes out of the research labs.
Consequently, teams can over-estimate their own ability to develop a
drug, and may defer or even avoid critical tests to determine its true
potential in case they give a negative result. This results in costly late-
stage failures when the drug’s true potential ultimately reveals
itself, as it always does (sometimes even after approval).
Alternatively, teams may be encouraged to kill their projects early to
avoid such costly late-stage failures, however this can have significant
opportunity costs if good drugs are terminated before sufficient data
is available to confirm their (lack of) intrinsic potential.
Therefore, development teams must learn that their ultimate goal is
to discover the intrinsic potential of a drug candidate, not to make it
succeed or fail. This requires a brave, pioneering mindset to ask the
right questions and test critical hypotheses in an unbiased, objective
manner, in the true spirit of scientific discovery.
                                                                  ©KelvinStott2012
Risk ≠ Prob. of Failure ≠ Potential Loss ≠ Risk-Adjusted Value

  Scenario                                       Upside
   Value                                          risk



                Risk-adjusted         Downside
                value (eNPV)            risk




                                                      Probability
                Potential       Probability
                  loss           of failure



                                                                ©KelvinStott2012
Shareholders are interested in risk as it relates to
uncertainty (volatility) in their expected return
Risk is a function of both probability and impact
   Risk is the expected (probability-weighted average)
   deviation (impact) from the expected value/return
   across all potential scenarios
   Based on uncertainty in all potential value drivers
Probability (PoS) is a key value driver, but a poor
and misleading indicator of risk
   PoS does not capture impact of success or failure on
   volatility in overall expected value/ROI
   Expected value increases linearly with PoS, but risk &
   uncertainty are greatest at 50% PoS (coin flip)
                                                    ©KelvinStott2012
Value




                                Value




                                                                Value
                       Prob.
                                                     Prob.                           Prob.


               0% PoS                        50% PoS                       100% PoS
          min value, no risk            mid value, max risk             max value, no risk



                   Value/Risk

        Expected Value                                                    Downside Risk
         = PoS x Upside                                                   = PoS x (1-PoS)
        Value + (1-PoS) x                                                x (Upside Value -
        Downside Value                                    PoS            Downside Value)

                                                                                         ©KelvinStott2012
Value in $millions                Project A   Project B
Probability of Success              50%         25%
Upside Value (potential gain)       500         700
Downside Value (potential loss)     -300        -100
Expected Value (1 project)          100         100
    Expected Loss                   150          75
    Downside Risk vs EV             200         150
    Standard Deviation              400         346
    Mean Abs. Deviation             400         300
Expected Value (10 projects)       1,000       1,000
    Expected Loss                   156          94
    Downside Risk vs EV             492         451
    Standard Deviation             1,265       1,095
    Mean Abs. Deviation             984         901
                                                       ©KelvinStott2012
4 simple options have the same expected value of $100:
   Which is the “MOST RISKY” option?
    1. Gain $100 (100% probability)
    2. Gain $300 (75%) or lose $500 (25%)
    3. Gain $500 (50%) or lose $300 (50%)
    4. Gain $700 (25%) or lose $100 (75%)
   13% of experts1 chose Option 1 as “most risky”
   26% chose Option 2 based on potential loss only
   26% chose Option 4 based on probability only
   Only 35% chose correct Option 3 based on potential loss
   and probability combined2
1. LinkedIn survey of over 800 professional risk managers, financial analysts and investors
2. Greatest risk according to all key risk metrics: expected loss ($150); downside risk vs EV ($200);
   standard deviation ($400); mean absolute deviation vs EV ($400)
                                                                                           ©KelvinStott2012
Value/ROI
                                    ± RISK


                    Sales, P&L, cash flow forecasts ± RISK

 Technical &
                 Operational     Commercial            BD&L           Financial
  regulatory
PoS by phase     R&D costs       Target patients   Licensing fees   Discount rate
Prob. approval   R&D timelines   Market share      Dev. m’stones    DSI, DSO, DPO
                 Launch date     Adoption rate     Sales m’stones   Exchange rates
                 Capex           Dose & compl.     Royalty rates    Inflation rates
                 COGS            Net price                          Tax rates
                 S&M costs       New entrants
                 G&A costs       Generic entry
                                 Other factors
                                                                            ©KelvinStott2012
Corporate Value ± RISK


                R&D portfolio              Comm. portfolio
                 Value ± RISK                Value ± RISK

 TA portfolio        TA portfolio         TA portfolio        TA portfolio
 Value ± RISK        Value ± RISK         Value ± RISK        Value ± RISK

Project   Project   Project   Project   Product   Product   Product   Product
 Value     Value     Value     Value     Value     Value     Value     Value
± RISK    ± RISK    ± RISK    ± RISK     ± RISK    ± RISK    ± RISK    ± RISK



                                                                      ©KelvinStott2012
Left &
right brain
   work
 together




              ©KelvinStott2012
Detail-oriented, short-term thinking and analysis loses
sight of the big picture and limits creativity & innovation
to incremental improvements on current practice
Implementation of quick fixes and short-term processes
without solving fundamental issues increases risk and
complexity, causes more problems in the long term and
creates a vicious cycle of continuous firefighting
Reliance on analyzing data to predict the future without
incorporating intuition and imagination increases risk by
assuming the future will look like the past
Main risk is that people are too busy watching the dials
to look out the window when the train is about to crash
Humans have evolved to manage risk by applying both
left and right brain thinking; neither has been sufficient
alone to survive, so it is critical to use both together
                                                     ©KelvinStott2012
©KelvinStott2012
Tools and processes are implemented to help an
organization achieve its objectives, however the
organization often ends up supporting its tools &
processes at the expense of its objectives
Tools and processes usually introduce constraints
that help to ensure consistency, however people
tend to switch off their brains because they regard
the tool/process as a substitute for free thinking
Finally, tools & processes are often implemented
without proper foresight and testing, so they end
up causing more problems than they solve
                                              ©KelvinStott2012
So what?
                                       Project/Portfolio        What if… ?
                                           Manager




Annualised R&D     Annualised sales     Production cost    Annualised S&M       BD&L / financial
cost forecasts &     forecasts by         forecasts by     cost forecasts by     parameters by
 attrition rates   country/scenario    country/scenario    country/scenario    country/scenario




  R&D teams        Bus. Intelligence   Tech. Operations    Sales & Marketing   BD&L / Finance


   Discrete           Discrete             Discrete            Discrete            Discrete
 assumptions        assumptions          assumptions         assumptions         assumptions

                                                                                    ©KelvinStott2012
In order to manage great complexity, companies
segregate and manage information in separate
parts of the organization, but this creates silos by
reducing connectivity and transparency
Companies then develop more processes and hire
“interface managers” to manage the flow of
information between silos, however this increases
complexity further by adding yet more
interfaces, thus creating a vicious cycle.
Moreover, organizations are primarily designed to
manage people, projects & resources, rather than
information as their ultimate business asset
                                               ©KelvinStott2012
Top-down                                   External
 analysis                                  advisors


Bottom-up                                  Internal
 analysis                                  experts




            Mean   Spread   Skew   Shape


                                             ©KelvinStott2012
All predictive models are based on assumptions, but the
assumptions are often based on limited data and ignore
key sources of information, for example:
   Probabilities of success are often over-estimated by teams
   believing that their projects are more likely to succeed than
   industry benchmarks, without considering that every team
   thinks the same about its own projects, and without asking
   external experts for a more balanced objective opinion
   Expected costs and timelines are often based on ambitious
   project plans, without taking into account a known history
   of project delays and budget deviations
Furthermore, the distribution of data is ignored where
discrete assumptions are calculated as average expected
values that are precisely wrong, while any uncertainty
and sensitivities in the assumptions become invisible so
that overall risk cannot be evaluated and managed
                                                         ©KelvinStott2012
©KelvinStott2012
Risk is complex, includes continuous as well as discrete
probability distributions, but models are usually based
only on discrete scenarios & simple probabilities
Such discrete probability models do not include the full
spectrum of potential scenarios, especially the rare and
extreme outliers (black swans) as well as intermediate
scenarios, so the temptation is to model more discrete
scenarios in order to improve accuracy
However, this costs more time and effort, and just adds
more noise and complexity without increasing accuracy
because the underlying data are ultimately limited
Modeling with continuous probability distributions can
solve this problem, but is not common practice
                                                   ©KelvinStott2012
Discrete




             Complex




Continuous




                       ©KelvinStott2012
Perceived
                         accuracy
                         Time & effort
                         Noise and
                         complexity
                         Accuracy




                         Transparency

No. scenarios modelled
                                ©KelvinStott2012
Includes the complete spectrum of all possible
scenarios, including intermediate scenarios and
rare/extreme outliers (“black swan” events)
Simple and transparent, with no more than 4
parameters to define the complete “shape” of
uncertainty in each value/risk driver
Can be easily modeled on historic data as well
as the forward-looking intuition of experts (or
even an integrated combination of the two)
Supports automatic Monte Carlo simulations
                                          ©KelvinStott2012
Risk-averse                                              Risk-averse
leaders continue                                         leaders make
to act in a “safe”                        Risk-averse    “safe” decisions
way in order to      Risk-averse                         by following the
                                           decisions
further advance      leadership                          pack, avoiding
their careers in                                         risk in the new
the company                     RISK-AVERSE              and unknown
                               CULTURE, RESI
                                 STANT TO
Employees are                     CHANGE                 Employees act in
hired and then                                           a “safe” manner
promoted based        Risk-averse          Risk-averse   to advance their
on their “safe”         hiring &           behaviour     careers, as risk-
and steady track      promotion                          taking innovators
record, decisions                                        get pushed out –
and behaviour                                            or fed up & quit

                                                                 ©KelvinStott2012
©KelvinStott2012
©KelvinStott2012
©KelvinStott2012
Source: Bernstein Research, 2010
                                   ©KelvinStott2012
Bobcat climbs cactus to escape hungry lion




                                         ©KelvinStott2012
1. Too many ambiguous, conflicting goals
2. Misaligned performance metrics
3. Objective bias and illusion of control
4. Fundamental misunderstanding of risk
5. Left brain vs right brain mindset
6. Over-reliance on tools and processes
7. Managing information in silos
8. Ignoring key sources of information
9. Over-modeling discrete scenarios
10. Risk-averse culture and leadership
                                            ©KelvinStott2012
Information overload
Increasing complexity
                         Decreasing R&D
Communication issues
                         productivity as
Data/detail vs insight   the right things
                         are not done at
Reduced transparency
                          the right time
Decreased objectivity
Slow & poor decisions

                                      ©KelvinStott2012
Pharma R&D productivity crisis
Fundamental issues & insights
   Pharma industry challenges
   Top 10 organizational issues
Key elements of a complete solution
A new fully integrated approach
   Concept
   Process
Case study: Phase 2 project
Conclusion & key messages
                                      ©KelvinStott2012
Clear, fully aligned strategic objectives and metrics
based on a solid understanding of value & risk
Shift culture/mindset to more big picture thinking
by integrating and automating information & data
management to provide real insight in real time
   Fully integrated system to evaluate and manage risk-
   return profile of projects & portfolios in real time
   Automatically manages and integrates all key sources
   of data, including internal/external expert intuition
   Fully consistent, transparent & objective; incorporates
   uncertainty in all key value drivers
Strong leadership with a risk appetite to step out
from the pack, challenge current thinking, and try
the new & unknown (especially in recruitment)
                                                    ©KelvinStott2012
Pharma R&D productivity crisis
Fundamental issues & insights
   Pharma industry challenges
   Top 10 organizational issues
Key elements of a complete solution
A new fully integrated approach
   Concept
   Process
Case study: Phase 2 project
Conclusion & key messages
                                      ©KelvinStott2012
©KelvinStott2012
Available
        options



Risk


                                          Risk
                                        appetite


                   Expected Value/ROI
                                                   ©KelvinStott2012
Risk




       Expected Value/ROI
                            ©KelvinStott2012
Phase 3
                             projects

                                          Current
                                          products


Risk                                     BD&L
                                        options
                  Phase 2
                  projects

       Phase 1
       projects


        Expected Value/ROI
                                                     ©KelvinStott2012
Risk


                              Risk
                            appetite


       Expected Value/ROI
                                       ©KelvinStott2012
Available
        options



Risk


                                          Risk
                                        appetite


                   Expected Value/ROI
                                                   ©KelvinStott2012
©KelvinStott2012
Instant Feedback




Analysis                         Discussion




           Options & Scenarios
                                              ©KelvinStott2012
-30      -20       -10        0         10         20       30    40      50        60
 INPUT
 Scenarios & Assumptions                                                                                                                                                                                                                                                                                                                                                                                Corp. tax rate                                   7.4
 Input Parameter                                         Unit     Default  Scen. 1         Scen. 2    Scen. 3         Scen. 4   Scen. 5          Scen. 6     SD                                                                                                                                                                                                                                                                                          7.4
 Accounting      Tax             Corp. tax rate           %          30.0%
                                                                                                                                                                                                                                                                                                                                                                                                        Prob. deferral
 parameters                      Prob. deferral           %                                                                                                                                                                                                                                                                                                                                            Inventory (DSI)                                   7.4
                 WCap            Inventory (DSI)         days
                                 Acc. receivable         days                                                                                                                                                                                                                                                                                                                                         Acc. receivable                                    7.4
                                                                                                                                                                                                                                                                                                                                                                                                                                                         7.4

                                                                                                                                                                                            Available
                                 Acc. payable            days                                                                                                                                                                                                                                                                                                                                            Acc. payable
                     NPV         Discount rate            %           8.5%
 Global R&D          Preclinical Phase duration           mo           18.0          0.0                                                                            3.0                                                                                                                                                                                                                                 Discount rate                                    7.4
                                 Total costs              €M            5.0          0.0                                                                            1.0                                                                                                                                                                                                                               Phase duration                                 7.0 7.9
                                 Prob. success            %          75.0%       100.0%
                     Phase 1     Phase duration           mo           24.0          0.0                                                                            4.0                                                                                                                                                                                                                                   Total costs                               6.7 8.1
                                 Total costs              €M           15.0          0.0                                                                            3.0
                                                                                                                                                                                                                                                                                                                                                                                                       Prob. success                            1.0          11.1


                                                                                                                                                                                             options
                                 Prob. success            %          65.0%       100.0%
                     Phase 2     Phase duration           mo           30.0                                                                                         5.0                                                                                                                                                                                                                               Phase duration                                 6.7 8.3
                                 Total costs              €M           50.0                                                                                        10.0
                                 Prob. success            %          30.0%                                                                                                                                                                                                                                                                                                                                Total costs                               6.0   8.8
                     Phase 3     Phase duration           mo           42.0                                                                                         7.0                                                                                                                                                                                                                                Prob. success                  -5.9                            17.1
                                 Total costs              €M          175.0                                                                                        25.0
                                 Prob. success            %          70.0%                                                                                                                                                                                                                                                                                                                            Phase duration                                6.1     9.0
                     Registrn. Phase duration             mo           18.0                                                                                         6.0                                                                                                                                                                                                                                                                            4.8       10.0
                                 Total costs              €M            5.0                                                                                         1.0
                                                                                                                                                                                                                                                                                                                                                                                                          Total costs
                                 Prob. success            %          80.0%                                                                                                                                                                                                                                                                                                                             Prob. success -23.6                                                                         54.7
 Sales growth        Timing      Delay to Launch          mo
                     Patients
 without special risks           Total patient popn.       K        1,000.0                                                                                       100.0                                                                                                                                                                                                                               Phase duration                               5.0       10.2
 & events                          Annual increase         K                                                                                                                                                                                                                                                                                                                                              Total costs                               5.9     8.9
                                 Target segment           %         100.0%
                                 Peak patient share       %         100.0%                                                                                                                                                                                                                                                                                                                             Prob. success    -19.8                                                25.2
                                   Current share          %                                                                                                                                                                                                                                                                                                                                           Phase duration                               5.2       10.0
                                   Adoption rate          %          40.0%                                                                                    10.0%
                     Units       Units/patient/year        N            1.0                                                                                                                                                                                                                                                                                                                               Total costs                                      7.4
                                   Compliance rate        %         100.0%
                     Price       Net price/Unit at L       €         400.00                                                                                   100.00
                                                                                                                                                                                                                                                                                                                                                                                                       Prob. success          -13.4                                   17.8
                                   Inflation rate         %                                                                                                                                                                                                                                                                                                                                          Delay to Launch                                       7.4
 Special risks & Generics & Event probability             %          80.0%
 events              biosimilars Expected date            mo      21.2.2032                                                                                    36.0                                                                                                                                                                                                                                Total patient popn.                           3.2           11.6
                                 Volm decrease            %          50.0%                                                                                    10.0%                                                                                                                                                                                                                                  Annual increase                                       7.4
                                 Price decrease           %          20.0%                                                                                    10.0%
                                 Rate of impact           %          50.0%                                                                                    10.0%                                                                                                                                                                                                                                  Target segment                                        7.4
                     Event 2     Event probability        %                                                                                                                                                                                                                                                                                                                                                                                                7.4
                                 Expected date            mo
                                                                                                                                                                                                                                                                                                                                                                                                   Peak patient share
                                 Volm decrease            %                                                                                                                                                                                                                                                                                                                                             Current share                                      7.4
                                 Price decrease           %
                                 Rate of impact           %                                                                                                                                                                                                                                                                                                                                             Adoption rate                             4.1        9.6
                     Event 3     Event probability        %                                                                                                                                                                                                                                                                                                                                         Units/patient/year                                     7.4
                                 Expected date            mo
                                 Volm decrease            %                                                                                                                                                                                                                                                                                                                                          Compliance rate                                       7.4
                                 Price decrease           %                                                                                                                                                                                                                                                                                                                                                                              -3.0                         17.8
                                 Rate of impact           %
                                                                                                                                                                                                                                                                                                                                                                                                    Net price/Unit at L
                     Event 4     Event probability        %                                                                                                                                                                                                                                                                                                                                              Inflation rate                                  7.4
                                 Expected date            mo
                                 Volm decrease            %                                                                                                                                                                                                                                                                                                                                         Event probability                              5.2       11.8
                                 Price decrease           %                                                                                                                                                                                                                                                                                                                                             Expected date                             3.8      10.2
                                 Rate of impact           %
                     Event 5     Event probability        %                                                                                                                                                                                                                                                                                                                                           Volm decrease                                 6.2 8.6
                                 Expected date            mo                                                                                                                                                                                                                                                                                                                                          Price decrease                                6.6 8.1
                                 Volm decrease            %
                                 Price decrease           %                                                                                                                                                                                                                                                                                                                                           Rate of impact                                 7.1 7.9
                                 Rate of impact           %
                     Event 6     Event probability        %
                                                                                                                                                                                                                                                                                                                                                                                                    Event probability                                    7.4
                                 Expected date            mo                                                                                                                                                                                                                                                                                                                                            Expected date                                    7.4
                                 Volm decrease            %
                                 Price decrease           %                                                                                                                                                                                                                                                                                                                                           Volm decrease                                      7.4
                                 Rate of impact           %                                                                                                                                                                                                                                                                                                                                           Price decrease                                     7.4
                     Event 7     Event probability        %
                                 Expected date            mo                                                                                                                                                                                                                                                                                                                                          Rate of impact                                     7.4
                                 Volm decrease            %                                                                                                                                                                                                                                                                                                                                                                                              7.4
                                                                                                                                                                                                                                                                                                                                                                                                    Event probability

                                                                                                                                                                                                                                                                                                                               Risk
                                 Price decrease           %
                                 Rate of impact           %                                                                                                                                                                                                                                                                                                                                             Expected date                                    7.4
                     Event 8     Event probability        %
                                 Expected date            mo                                                                                                                                                                                                                                                                                                                                          Volm decrease                                      7.4
                                 Volm decrease            %                                                                                                                                                                                                                                                                                                                                           Price decrease                                     7.4
                                 Price decrease           %                                                                                                                                                                                                                                                                                                                                                                                              7.4
                                 Rate of impact           %                                                                                                                                                                                                                                                                                                                                           Rate of impact


                                                                                                                                                                                                                                                                                                                             appetite
 Explicit assumptions &                                                                                                                                                                                                                                                                                                                                                                           Sensitivity analysis of
probability distributions                                                                                                                                                                                                                                                                                                                                                                         key value/risk drivers
   80.0                                                                                                                                                                      1,600.0                                                                               25.0                                                                                                                         2,500.0
                                                                                                                                                                                                                                                                                  Preclinical         Phase 1            Phase 2          Phase 3              Registrn.          Phase 4
   70.0
                                                                                                                                                                             1,400.0                1,360.1    1,360.1
                                                                                                                                                                                                                                                                                   20.0                                                                                                         2,000.0
   60.0                                                                                                                                                                                                                                                            20.0
                                                                                                                                                                             1,200.0                                                                                                       18.2
   50.0                                                                                                                                                                                                                                                                   17.0
                                                                                                                                                                                                                                                                                                                                                                                                1,500.0
   40.0                                                                                                                                                                      1,000.0                                                                                                               15.0 15.0 15.0
                                                                                                                                                                                                                                                                   15.0
   30.0
                                                                                                                                                                              800.0                                                                                                                                                                                                             1,000.0
                                                                                                                                                                                                                           697.0
   20.0
                                                                                                                                                                                                                                                                   10.0
   10.0                                                                                                                                                                       600.0
                                                                                                                                                                                                                                    487.9        487.9                                                                                                                                           500.0
    0.0
                                                                                                                                                                              400.0
               2012

                        2014

                                2016

                                         2018

                                                  2020

                                                           2022

                                                                   2024

                                                                          2026

                                                                                    2028

                                                                                             2030

                                                                                                     2032

                                                                                                               2034

                                                                                                                        2036

                                                                                                                                2038

                                                                                                                                          2040

                                                                                                                                                    2042

                                                                                                                                                           2044

                                                                                                                                                                      2046




                                                                                                                                                                                                                                                                    5.0
  -10.0                                                                                                                                                                                                                                                                                                                                                                                             0.0
                                                                                                                                                                                                                                                                                                                          2.8
                                                                                                                                                                              200.0                                                                                                                                                                                                                       0%   10%       20%      30%        40%          50%       60%       70%    80%     90%       100%
  -20.0                                                                                                                                                                                  103.6
                                                                                                                                                                                                                                                            61.8
                                                                                                                                                                                                                                                                                                                                 0.5
                                                                                                                                                                                                                                                                                                                                          0.0    0.0    0.0       0.0      0.0    0.0    0.0
  -30.0                                                                                                                                                                         0.0                                                                                 0.0                                                                                                                          -500.0
                                                                                                                                                                                                                                                                           2011

                                                                                                                                                                                                                                                                                    2012

                                                                                                                                                                                                                                                                                            2013

                                                                                                                                                                                                                                                                                                    2014

                                                                                                                                                                                                                                                                                                           2015

                                                                                                                                                                                                                                                                                                                  2016

                                                                                                                                                                                                                                                                                                                          2017

                                                                                                                                                                                                                                                                                                                                   2018

                                                                                                                                                                                                                                                                                                                                          2019

                                                                                                                                                                                                                                                                                                                                                 2020

                                                                                                                                                                                                                                                                                                                                                        2021

                                                                                                                                                                                                                                                                                                                                                                  2022

                                                                                                                                                                                                                                                                                                                                                                           2023

                                                                                                                                                                                                                                                                                                                                                                                  2024

                                                                                                                                                                                                                                                                                                                                                                                         2025
                                                                                                                                                                                       R&D Costs   Net Sales   G. Margin   EBIT    Net Profit   Cash Flow   NPV
                      R&D Costs             Net Sales                Margin                EBIT             Net Profit           Cash Flow                 NPV                                                                                                                                                                                                                                                 Value      Vmean         Vexp         Vmed        Vmin         Vmax    Risk threshold




 Automatic sales, P&L                                                                                                                                                          Cumulative forecasts                                                                  Risk-adjusted R&D                                                                                                            Monte Carlo analysis
 & cash flow forecasts                                                                                                                                                           over any period                                                                    costs by phase/year                                                                                                           of NPV, any P&L item
                                                                                                                                                                                                                                                                                                                                                                                                                                                                ©KelvinStott2012
Pharma R&D productivity crisis
Fundamental issues & insights
   Pharma industry challenges
   Top 10 organizational issues
Key elements of a complete solution
A new fully integrated approach
   Concept
   Process
Case study: Phase 2 project
Conclusion & key messages
                                      ©KelvinStott2012
Evaluate                                            Evaluate
risk-return                                         risk-return
profile of                          EVALUATE        profile of
              EVALUATE
current                             OPTIONS         options &
              PROGRESS
plan                                                scenarios

                         RISK-RETURN
                         OPTIMIZATION

Execute                                   MAKE      Select best
updated         EXECUTE                             option(s)
                                        DECISIONS
               DECISIONS
plan and                                            based on
monitor                                             risk-return
progress                                            profile

                                                           ©KelvinStott2012
Value
                                    & ROI

                        Sales, P&L, cash flow forecasts

 Technical &     Operational     Commercial            BD&L           Financial
  regulatory     value drivers   value drivers     value drivers    value drivers
PoS by phase     R&D costs       Target patients   Licensing fees   Discount rate
Prob. approval   R&D timelines   Market share      Dev. m’stones    DSI, DSO, DPO
                 Launch delay    Adoption rate     Sales m’stones   Exchange rates
                 Capex           Dose & compl.     Royalty rates    Inflation rates
                 COGS            Net price                          Tax rates
                 S&M costs       New entrants
                 G&A costs       Generic impact
                                 Other factors
                                                                            ©KelvinStott2012
Top-down                                   External
 analysis                                  advisors


Bottom-up                                  Internal
 analysis                                  experts




            Mean   Spread   Skew   Shape


                                             ©KelvinStott2012
Value
                                    & ROI

                        Sales, P&L, cash flow forecasts

 Technical &     Operational     Commercial            BD&L           Financial
  regulatory     value drivers   value drivers     value drivers    value drivers
PoS by phase     R&D costs       Target patients   Licensing fees   Discount rate
Prob. approval   R&D timelines   Market share      Dev. m’stones    DSI, DSO, DPO
                 Launch delay    Adoption rate     Sales m’stones   Exchange rates
                 Capex           Dose & compl.     Royalty rates    Inflation rates
                 COGS            Net price                          Tax rates
                 S&M costs       New entrants
                 G&A costs       Generic impact
                                 Other factors
                                                                            ©KelvinStott2012
Value                    Upside risk
(NPV)

            Expected
          value (eNPV)




                                 Probability
        Downside risk


                                           ©KelvinStott2012
Risk




       Expected Value/ROI
                            ©KelvinStott2012
Value driver     Uncertainty   Project value/ROI ± risk
Phase 3 PoS

R&D timelines

Phase 2 PoS

Market share

R&D costs

Generic impact

COGS

                                                   ©KelvinStott2012
Value
                                    & ROI

                        Sales, P&L, cash flow forecasts

 Technical &     Operational     Commercial            BD&L           Financial
  regulatory     value drivers   value drivers     value drivers    value drivers
PoS by phase     R&D costs       Target patients   Licensing fees   Discount rate
Prob. approval   R&D timelines   Market share      Dev. m’stones    DSI, DSO, DPO
                 Launch delay    Adoption rate     Sales m’stones   Exchange rates
                 Capex           Dose & compl.     Royalty rates    Inflation rates
                 COGS            Net price                          Tax rates
                 S&M costs       New entrants
                 G&A costs       Generic impact
                                 Other factors
                                                                            ©KelvinStott2012
Risk


                              Risk
                            appetite


       Expected Value/ROI
                                       ©KelvinStott2012
Risk


                              Risk
                            appetite


       Expected Value/ROI
                                       ©KelvinStott2012
Negative   Positive
        data       data


Risk




         Expected Value/ROI
                              ©KelvinStott2012
EVALUATE
                 EVALUATE
                                            OPTIONS
                 PROGRESS


 Research     Preclinical        Clinical       Approval    Lifecycle
& discovery   developmt.       developmt.       & Launch   managemt.

                                              MAKE
                    EXECUTE
                                            DECISIONS
                   DECISIONS




                                                                ©KelvinStott2012
Individual R&D projects (early or late-stage)
Marketed products (branded or generic)
BD&L opportunities (in & out-licensing deals)
Entire portfolios (R&D or commercial)




                                          ©KelvinStott2012
Pharma R&D productivity crisis
Fundamental issues & insights
   Pharma industry challenges
   Top 10 organizational issues
Key elements of a complete solution
A new fully integrated approach
   Concept
   Process
Case study: Phase 2 project
Conclusion & key messages
                                      ©KelvinStott2012
Phase 2 NCE for pancreatic cancer, new
MoA, about to enter large Phase 3 trial
Similar safety & efficacy profile vs competitor
Positive eNPV
BUT: current plan feels too risky
   Lack of clear dose response in Phase 2
   Relatively low PoS (50%) in Phase 3
   Significant uncertainty in potential market
   Key competitor already in Phase 3

                                                 ©KelvinStott2012
Phase 3: $120(±10)m, 36(±6)mo, 50% PoS
Approval: $15(±3)m, 12(±3)mo, 90% PoS
Peak sales: $800(±300)m (50% within 24 mo)
Competitor: 50% probability to launch in 2
yrs, reducing peak sales by 65(±10)%
Generics: lose 80(±5)% sales after 12 yrs
10(±2)% COGS, 60(±5)% SG&A costs, 30% tax
8.0% discount rate

                                       ©KelvinStott2012
Input Parameter                                     Unit   Default     Scen. 1   Scen. 2   Scen. 3   Scen. 4   Scen. 5   Scen. 6   ±SD
Accounting        Tax         Corp. tax rate         %        30.0%                                                                                                                250.0
parameters                    Prob. deferral         %
                  WCap        Inventory (DSI)       days
                              Acc/R (DSO)           days
                              Acc/P (DPO)           days                                                                                                                           200.0




                                                                                                                                               Annual P&L / Cash Flow (millions)
                  NPV         Discount rate          %         8.0%
Global R&D        Preclinical Phase duration         mo
                              Total costs            $M
                              Prob. success          %                                                                                                                             150.0
                  Phase 1     Phase duration         mo
                              Total costs            $M
                              Prob. success          %




                                                                                                                                                                                                                                                                                                                           End of Period
                  Phase 2     Phase duration         mo
                              Total costs            $M
                                                                                                                                                                                   100.0
                              Prob. success          %
                  Phase 3     Phase duration         mo         36.0                                                                  6.0
                              Total costs            $M        120.0                                                                 10.0
                              Prob. success          %        50.0%                                                                                                                 50.0
                  Registrn.   Phase duration         mo         12.0                                                                     3.0
                              Total costs            $M         15.0                                                                     3.0
                              Prob. success          %        90.0%
Sales growth      Timing      Delay to Launch        mo                                                                                                                               0.0
without special   Patients    Total patient popn.     K       800.0                                                                 300.0
risks & events                  Annual increase       K
                              Target segment         %      100.0%
                              Peak patient share     %      100.0%                                                                                                                  -50.0
                                Current share        %
                                Uptake rate (t½)     mo        24.0
                  Units       Units/patient/year      N         1.0
                                Compliance rate      %      100.0%                                                                                                                 -100.0
                  Price       Net price/Unit at L     $    1,000.00




                                                                                                                                                                                            2012

                                                                                                                                                                                                   2014

                                                                                                                                                                                                          2016

                                                                                                                                                                                                                 2018

                                                                                                                                                                                                                         2020

                                                                                                                                                                                                                                2022

                                                                                                                                                                                                                                       2024

                                                                                                                                                                                                                                              2026

                                                                                                                                                                                                                                                     2028

                                                                                                                                                                                                                                                            2030

                                                                                                                                                                                                                                                                      2032

                                                                                                                                                                                                                                                                              2034

                                                                                                                                                                                                                                                                                     2036

                                                                                                                                                                                                                                                                                              2038

                                                                                                                                                                                                                                                                                                     2040

                                                                                                                                                                                                                                                                                                            2042

                                                                                                                                                                                                                                                                                                                    2044

                                                                                                                                                                                                                                                                                                                           2046
                                Inflation rate       %
Special risks &   Generics & Event probability       %       100.0%
events            biosimilars Expected date          mo    16/Apr/24
                              Volm increase          %       -80.0%                                                                  5.0%                                                   Net Sales             Gross Margin                EBIT                 Net Profit               Cash Flow               DCF
                              Price increase         %
                              Impact rate (t½)       mo         24.0
                  Comp. 1     Event probability      %        50.0%
                              Expected date          mo    16/Apr/14
                              Volm increase          %       -65.0%                                                                 10.0%
                              Price increase         %
                                                                                                                                                                                   3,500.0
                              Impact rate (t½)       mo        24.0
                  Comp. 2     Event probability      %                                                                                                                                              3,078.6
                              Expected date          mo
                              Volm increase          %                                                                                                                             3,000.0
                              Price increase         %                                                                                                                                                                   2,770.7
                              Impact rate (t½)       mo




                                                                                                                                               Total P&L / Cash Flow (millions)
                  Tech shift  Event probability      %
                              Expected date          mo
                              Volm increase          %                                                                                                                             2,500.0
                              Price increase         %
                              Impact rate (t½)       mo
                  Event 5     Event probability      %
                              Expected date          mo
                              Volm increase          %                                                                                                                             2,000.0
                              Price increase         %
                              Impact rate (t½)       mo
                  Event 6     Event probability      %
                              Expected date          mo
                              Volm increase          %
                                                                                                                                                                                   1,500.0
                              Price increase         %
                              Impact rate (t½)       mo
                  Event 7     Event probability      %
                              Expected date          mo                                                                                                                            1,000.0
                              Volm increase          %                                                                                                                                                                                        796.1
                              Price increase         %
                              Impact rate (t½)       mo
                                                                                                                                                                                                                                                                      557.2                  557.2
                  Event 8     Event probability      %
                              Expected date          mo                                                                                                                             500.0
                              Volm increase          %
                              Price increase         %                                                                                                                                                                                                                                                             152.8
                              Impact rate (t½)       mo
Prodn costs       COGS        COGS per Unit           $
                                (or % sales)         %        10.0%                                                                  2.0%                                              0.0
                  Deprecn     Depreciation/Unit       $                                                                                                                                            Net Sales            G. Margin              EBIT                 Net Profit          Cash Flow                  NPV
                                (or % sales)         %



                                                                                                                                                                                                                                                                                                ©KelvinStott2012
New Approach to Pharma R&D / PPM
New Approach to Pharma R&D / PPM
New Approach to Pharma R&D / PPM
New Approach to Pharma R&D / PPM
New Approach to Pharma R&D / PPM
New Approach to Pharma R&D / PPM
New Approach to Pharma R&D / PPM
New Approach to Pharma R&D / PPM
New Approach to Pharma R&D / PPM
New Approach to Pharma R&D / PPM
New Approach to Pharma R&D / PPM
New Approach to Pharma R&D / PPM
New Approach to Pharma R&D / PPM
New Approach to Pharma R&D / PPM
New Approach to Pharma R&D / PPM
New Approach to Pharma R&D / PPM
New Approach to Pharma R&D / PPM

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New Approach to Pharma R&D / PPM

  • 1. Kelvin Stott PhD Pharma R&D Portfolio Strategy, Risk & Decision Consultant October 2012 ©KelvinStott2012
  • 2. This presentation explores some of the underlying issues responsible for declining pharma R&D productivity, and provides a new, fully integrated approach to reverse this trend by navigating R&D projects and portfolios through the risk-return landscape in real time A case study demonstrates how this system can be used in practice to improve the risk-return profile of a Phase 2 development project according to risk appetite This presentation focuses on R&D in the pharmaceutical industry, however the approach can be used to manage and optimize the risk-return profile of any business asset at any stage of its lifecycle, at any level, in any industry ©KelvinStott2012
  • 3. Pharma R&D productivity crisis Fundamental issues & insights Pharma industry challenges Top 10 organizational issues Key elements of a complete solution A new fully integrated approach Concept Process Case study: Phase 2 project Conclusion & key messages ©KelvinStott2012
  • 4. Pharma R&D productivity crisis Fundamental issues & insights Pharma industry challenges Top 10 organizational issues Key elements of a complete solution A new fully integrated approach Concept Process Case study: Phase 2 project Conclusion & key messages ©KelvinStott2012
  • 5. New technologies have done nothing to slow the steady decline in R&D productivity Note the log scale! Source: Bernstein Research, 2010 ©KelvinStott2012
  • 7. % of preclinical drug candidates successfully passing through each phase 35% 30% 25% Preclinical 20% Phase I 15% Phase II Phase III 10% Approval 5% 0% 1990-94 1995-99 2000-04 2005-09 ©KelvinStott2012
  • 8. More money, capital … people, FTEs … skills, know-how … data, information … tools, technologies … disease targets … projects, partners So why is Pharma R&D productivity declining so rapidly? ©KelvinStott2012
  • 9. Pharma R&D productivity crisis Fundamental issues & insights Pharma industry challenges Top 10 organizational issues Key elements of a complete solution A new fully integrated approach Concept Process Case study: Phase 2 project Conclusion & key messages ©KelvinStott2012
  • 10. • Tighter regulations Decreasing • Low reimbursement market • Pricing pressures potential • Increasing R&D Diminishing • Patent expiries timelines (time profit window • Generics and to market) (Value/ROI) biosimilars Decreasing R&D • Increasing R&D costs productivity • Higher attrition rates ©KelvinStott2012
  • 11. Decreasing Technical quality of new Decreasing drug leads success rates Increasing Commercial Increasing Decreasing standards & regulatory costs/project productivity of care Increasing Decreasing timelines Operational organizational effectiveness ©KelvinStott2012
  • 12. Technical accessibility Potential market by indication ©KelvinStott2012
  • 13. Technical accessibility Potential market by indication ©KelvinStott2012
  • 14. Technical accessibility Potential market by indication ©KelvinStott2012
  • 15. Current drugs have already exploited the most obvious leads with the lowest risk and greatest potential Small molecules based on known active natural products, ligands, substrates, dietary ingredients & traditional medicines Recombinant blood-based proteins to treat deficiencies in simple metabolic & genetic diseases (e.g., insulin, GH, factor VIII) Vaccines and antibodies against major pathogens, toxic proteins Remaining opportunities are technically more challenging or have limited commercial potential Highly complex diseases with no clear mechanism, target or lead Tissue-based diseases with significant barriers to drug delivery Rare diseases and sub-types with existing drugs or limited market Consequently, cost and risk have increased, like drilling for oil from less abundant, less accessible, lower quality sources ©KelvinStott2012
  • 16. Increasing competition More safe and effective drugs have become available, raising the standard to compete for market share Generic competition is adding further pressure on drug prices Improving regulatory standards Regulatory standards are continuously evolving to ensure patient welfare over current treatments with longer more costly trials, as regulators learn to avoid past issues (e.g., safety recalls) Increasing strain on healthcare budgets Soaring healthcare costs are now considered unsustainable while payers & providers are under increasing pressure to reduce costs Consequently, there has been increasing pressure to develop more safe and effective drugs at lower cost ©KelvinStott2012
  • 17. Increasing technical risk (innovation) Revolutionary Incremental Generics & Combination first-in-class improvements biosimilars: therapies and treatments of existing exact copies of improved based on new drugs based on existing drugs formulations of & unproven established competing on existing drugs target/MoA target/MoA price only Increasing commercial risk (competition) Regardless of strategy, overall risk is increasing with time ©KelvinStott2012
  • 18. Pharma R&D productivity crisis Fundamental issues & insights Pharma industry challenges Top 10 organizational issues Key elements of a complete solution A new fully integrated approach Concept Process Case study: Phase 2 project Conclusion & key messages ©KelvinStott2012
  • 19. 1. Too many ambiguous, conflicting goals 2. Misaligned performance metrics 3. Objective bias and illusion of control 4. Fundamental misunderstanding of risk 5. Left brain vs right brain mindset 6. Over-reliance on tools and processes 7. Managing information in silos 8. Ignoring key sources of information 9. Over-modeling discrete scenarios 10. Risk-averse culture and leadership ©KelvinStott2012
  • 20. Get new products to market Meet customer needs Maximize sales/profit/value/ROI/… Minimize/manage risk Maximize probability of success Optimize time, cost, quality Do the right projects, do them right Support the strategy Manage resources effectively ©KelvinStott2012
  • 21. What are the “right” projects/products? Which customers? How to balance their needs? What to maximize: sales, profit, value, ROI? At what risk? What is “risk”? How to define & measure success, quality, etc.? If our goal is to support the strategy, what is the goal of the strategy? Tail wagging the dog? How flexible is the current plan/budget? How to prioritize when goals are not aligned? ©KelvinStott2012
  • 22. Measured performance Shareholder interests Balanced scorecard No. ≠ Project Portfolio Value ± RISK Project Project approvals/milestones, time, Value Value Value cost, “quality”, etc. ± RISK ± RISK ± RISK ©KelvinStott2012
  • 23. Performance metrics are over-simplified and do not incorporate all key value/risk drivers Often based on quantity and defined by simple short-term operational milestones, e.g., No. of approvals/successful phase transitions No. of milestones achieved on time/budget Quality is judged subjectively, or measured only in part, e.g., strategic fit, probability of success Overall performance is calculated as weighted average, does not correlate with value and risk ©KelvinStott2012
  • 24. Value/ROI ± RISK Sales, P&L, cash flow forecasts ± RISK Technical & Operational Commercial BD&L Financial regulatory PoS by phase R&D costs Target patients Licensing fees Discount rate Prob. approval R&D timelines Market share Dev. m’stones DSI, DSO, DPO Launch date Adoption rate Sales m’stones Exchange rates Capex Dose & compl. Royalty rates Inflation rates COGS Net price Tax rates S&M costs New entrants G&A costs Generic entry Other factors ©KelvinStott2012
  • 25. Perception Reality Drug has intrinsic Positive bias potential to succeed (“get drug to market”) (safe & effective) ≠ ? Drug is inherently Negative bias unsafe, ineffective or (“kill projects early”) uncompetitive ©KelvinStott2012
  • 26. Probability of success Biased objective to succeed Costly late- Perceived stage failure potential Unbiased research Excess costs saved for other projects Intrinsic potential Development Time & Cost ©KelvinStott2012
  • 27. Intrinsic potential Unbiased research Perceived potential Biased objective to kill project early Probability of success Opportunity cost Development Time & Cost ©KelvinStott2012
  • 28. Naturally, project teams want their projects to succeed, and set their goals to develop a superior drug that is both safe and effective. However, many seem to forget that the potential of a drug to be safe and effective is an intrinsic property of the molecule which is already built into the drug when it comes out of the research labs. Consequently, teams can over-estimate their own ability to develop a drug, and may defer or even avoid critical tests to determine its true potential in case they give a negative result. This results in costly late- stage failures when the drug’s true potential ultimately reveals itself, as it always does (sometimes even after approval). Alternatively, teams may be encouraged to kill their projects early to avoid such costly late-stage failures, however this can have significant opportunity costs if good drugs are terminated before sufficient data is available to confirm their (lack of) intrinsic potential. Therefore, development teams must learn that their ultimate goal is to discover the intrinsic potential of a drug candidate, not to make it succeed or fail. This requires a brave, pioneering mindset to ask the right questions and test critical hypotheses in an unbiased, objective manner, in the true spirit of scientific discovery. ©KelvinStott2012
  • 29. Risk ≠ Prob. of Failure ≠ Potential Loss ≠ Risk-Adjusted Value Scenario Upside Value risk Risk-adjusted Downside value (eNPV) risk Probability Potential Probability loss of failure ©KelvinStott2012
  • 30. Shareholders are interested in risk as it relates to uncertainty (volatility) in their expected return Risk is a function of both probability and impact Risk is the expected (probability-weighted average) deviation (impact) from the expected value/return across all potential scenarios Based on uncertainty in all potential value drivers Probability (PoS) is a key value driver, but a poor and misleading indicator of risk PoS does not capture impact of success or failure on volatility in overall expected value/ROI Expected value increases linearly with PoS, but risk & uncertainty are greatest at 50% PoS (coin flip) ©KelvinStott2012
  • 31. Value Value Value Prob. Prob. Prob. 0% PoS 50% PoS 100% PoS min value, no risk mid value, max risk max value, no risk Value/Risk Expected Value Downside Risk = PoS x Upside = PoS x (1-PoS) Value + (1-PoS) x x (Upside Value - Downside Value PoS Downside Value) ©KelvinStott2012
  • 32. Value in $millions Project A Project B Probability of Success 50% 25% Upside Value (potential gain) 500 700 Downside Value (potential loss) -300 -100 Expected Value (1 project) 100 100 Expected Loss 150 75 Downside Risk vs EV 200 150 Standard Deviation 400 346 Mean Abs. Deviation 400 300 Expected Value (10 projects) 1,000 1,000 Expected Loss 156 94 Downside Risk vs EV 492 451 Standard Deviation 1,265 1,095 Mean Abs. Deviation 984 901 ©KelvinStott2012
  • 33. 4 simple options have the same expected value of $100: Which is the “MOST RISKY” option? 1. Gain $100 (100% probability) 2. Gain $300 (75%) or lose $500 (25%) 3. Gain $500 (50%) or lose $300 (50%) 4. Gain $700 (25%) or lose $100 (75%) 13% of experts1 chose Option 1 as “most risky” 26% chose Option 2 based on potential loss only 26% chose Option 4 based on probability only Only 35% chose correct Option 3 based on potential loss and probability combined2 1. LinkedIn survey of over 800 professional risk managers, financial analysts and investors 2. Greatest risk according to all key risk metrics: expected loss ($150); downside risk vs EV ($200); standard deviation ($400); mean absolute deviation vs EV ($400) ©KelvinStott2012
  • 34. Value/ROI ± RISK Sales, P&L, cash flow forecasts ± RISK Technical & Operational Commercial BD&L Financial regulatory PoS by phase R&D costs Target patients Licensing fees Discount rate Prob. approval R&D timelines Market share Dev. m’stones DSI, DSO, DPO Launch date Adoption rate Sales m’stones Exchange rates Capex Dose & compl. Royalty rates Inflation rates COGS Net price Tax rates S&M costs New entrants G&A costs Generic entry Other factors ©KelvinStott2012
  • 35. Corporate Value ± RISK R&D portfolio Comm. portfolio Value ± RISK Value ± RISK TA portfolio TA portfolio TA portfolio TA portfolio Value ± RISK Value ± RISK Value ± RISK Value ± RISK Project Project Project Project Product Product Product Product Value Value Value Value Value Value Value Value ± RISK ± RISK ± RISK ± RISK ± RISK ± RISK ± RISK ± RISK ©KelvinStott2012
  • 36. Left & right brain work together ©KelvinStott2012
  • 37. Detail-oriented, short-term thinking and analysis loses sight of the big picture and limits creativity & innovation to incremental improvements on current practice Implementation of quick fixes and short-term processes without solving fundamental issues increases risk and complexity, causes more problems in the long term and creates a vicious cycle of continuous firefighting Reliance on analyzing data to predict the future without incorporating intuition and imagination increases risk by assuming the future will look like the past Main risk is that people are too busy watching the dials to look out the window when the train is about to crash Humans have evolved to manage risk by applying both left and right brain thinking; neither has been sufficient alone to survive, so it is critical to use both together ©KelvinStott2012
  • 39. Tools and processes are implemented to help an organization achieve its objectives, however the organization often ends up supporting its tools & processes at the expense of its objectives Tools and processes usually introduce constraints that help to ensure consistency, however people tend to switch off their brains because they regard the tool/process as a substitute for free thinking Finally, tools & processes are often implemented without proper foresight and testing, so they end up causing more problems than they solve ©KelvinStott2012
  • 40. So what? Project/Portfolio What if… ? Manager Annualised R&D Annualised sales Production cost Annualised S&M BD&L / financial cost forecasts & forecasts by forecasts by cost forecasts by parameters by attrition rates country/scenario country/scenario country/scenario country/scenario R&D teams Bus. Intelligence Tech. Operations Sales & Marketing BD&L / Finance Discrete Discrete Discrete Discrete Discrete assumptions assumptions assumptions assumptions assumptions ©KelvinStott2012
  • 41. In order to manage great complexity, companies segregate and manage information in separate parts of the organization, but this creates silos by reducing connectivity and transparency Companies then develop more processes and hire “interface managers” to manage the flow of information between silos, however this increases complexity further by adding yet more interfaces, thus creating a vicious cycle. Moreover, organizations are primarily designed to manage people, projects & resources, rather than information as their ultimate business asset ©KelvinStott2012
  • 42. Top-down External analysis advisors Bottom-up Internal analysis experts Mean Spread Skew Shape ©KelvinStott2012
  • 43. All predictive models are based on assumptions, but the assumptions are often based on limited data and ignore key sources of information, for example: Probabilities of success are often over-estimated by teams believing that their projects are more likely to succeed than industry benchmarks, without considering that every team thinks the same about its own projects, and without asking external experts for a more balanced objective opinion Expected costs and timelines are often based on ambitious project plans, without taking into account a known history of project delays and budget deviations Furthermore, the distribution of data is ignored where discrete assumptions are calculated as average expected values that are precisely wrong, while any uncertainty and sensitivities in the assumptions become invisible so that overall risk cannot be evaluated and managed ©KelvinStott2012
  • 45. Risk is complex, includes continuous as well as discrete probability distributions, but models are usually based only on discrete scenarios & simple probabilities Such discrete probability models do not include the full spectrum of potential scenarios, especially the rare and extreme outliers (black swans) as well as intermediate scenarios, so the temptation is to model more discrete scenarios in order to improve accuracy However, this costs more time and effort, and just adds more noise and complexity without increasing accuracy because the underlying data are ultimately limited Modeling with continuous probability distributions can solve this problem, but is not common practice ©KelvinStott2012
  • 46. Discrete Complex Continuous ©KelvinStott2012
  • 47. Perceived accuracy Time & effort Noise and complexity Accuracy Transparency No. scenarios modelled ©KelvinStott2012
  • 48. Includes the complete spectrum of all possible scenarios, including intermediate scenarios and rare/extreme outliers (“black swan” events) Simple and transparent, with no more than 4 parameters to define the complete “shape” of uncertainty in each value/risk driver Can be easily modeled on historic data as well as the forward-looking intuition of experts (or even an integrated combination of the two) Supports automatic Monte Carlo simulations ©KelvinStott2012
  • 49. Risk-averse Risk-averse leaders continue leaders make to act in a “safe” Risk-averse “safe” decisions way in order to Risk-averse by following the decisions further advance leadership pack, avoiding their careers in risk in the new the company RISK-AVERSE and unknown CULTURE, RESI STANT TO Employees are CHANGE Employees act in hired and then a “safe” manner promoted based Risk-averse Risk-averse to advance their on their “safe” hiring & behaviour careers, as risk- and steady track promotion taking innovators record, decisions get pushed out – and behaviour or fed up & quit ©KelvinStott2012
  • 53. Source: Bernstein Research, 2010 ©KelvinStott2012
  • 54. Bobcat climbs cactus to escape hungry lion ©KelvinStott2012
  • 55. 1. Too many ambiguous, conflicting goals 2. Misaligned performance metrics 3. Objective bias and illusion of control 4. Fundamental misunderstanding of risk 5. Left brain vs right brain mindset 6. Over-reliance on tools and processes 7. Managing information in silos 8. Ignoring key sources of information 9. Over-modeling discrete scenarios 10. Risk-averse culture and leadership ©KelvinStott2012
  • 56. Information overload Increasing complexity Decreasing R&D Communication issues productivity as Data/detail vs insight the right things are not done at Reduced transparency the right time Decreased objectivity Slow & poor decisions ©KelvinStott2012
  • 57. Pharma R&D productivity crisis Fundamental issues & insights Pharma industry challenges Top 10 organizational issues Key elements of a complete solution A new fully integrated approach Concept Process Case study: Phase 2 project Conclusion & key messages ©KelvinStott2012
  • 58. Clear, fully aligned strategic objectives and metrics based on a solid understanding of value & risk Shift culture/mindset to more big picture thinking by integrating and automating information & data management to provide real insight in real time Fully integrated system to evaluate and manage risk- return profile of projects & portfolios in real time Automatically manages and integrates all key sources of data, including internal/external expert intuition Fully consistent, transparent & objective; incorporates uncertainty in all key value drivers Strong leadership with a risk appetite to step out from the pack, challenge current thinking, and try the new & unknown (especially in recruitment) ©KelvinStott2012
  • 59. Pharma R&D productivity crisis Fundamental issues & insights Pharma industry challenges Top 10 organizational issues Key elements of a complete solution A new fully integrated approach Concept Process Case study: Phase 2 project Conclusion & key messages ©KelvinStott2012
  • 61. Available options Risk Risk appetite Expected Value/ROI ©KelvinStott2012
  • 62. Risk Expected Value/ROI ©KelvinStott2012
  • 63. Phase 3 projects Current products Risk BD&L options Phase 2 projects Phase 1 projects Expected Value/ROI ©KelvinStott2012
  • 64. Risk Risk appetite Expected Value/ROI ©KelvinStott2012
  • 65. Available options Risk Risk appetite Expected Value/ROI ©KelvinStott2012
  • 67. Instant Feedback Analysis Discussion Options & Scenarios ©KelvinStott2012
  • 68. -30 -20 -10 0 10 20 30 40 50 60 INPUT Scenarios & Assumptions Corp. tax rate 7.4 Input Parameter Unit Default Scen. 1 Scen. 2 Scen. 3 Scen. 4 Scen. 5 Scen. 6 SD 7.4 Accounting Tax Corp. tax rate % 30.0% Prob. deferral parameters Prob. deferral % Inventory (DSI) 7.4 WCap Inventory (DSI) days Acc. receivable days Acc. receivable 7.4 7.4 Available Acc. payable days Acc. payable NPV Discount rate % 8.5% Global R&D Preclinical Phase duration mo 18.0 0.0 3.0 Discount rate 7.4 Total costs €M 5.0 0.0 1.0 Phase duration 7.0 7.9 Prob. success % 75.0% 100.0% Phase 1 Phase duration mo 24.0 0.0 4.0 Total costs 6.7 8.1 Total costs €M 15.0 0.0 3.0 Prob. success 1.0 11.1 options Prob. success % 65.0% 100.0% Phase 2 Phase duration mo 30.0 5.0 Phase duration 6.7 8.3 Total costs €M 50.0 10.0 Prob. success % 30.0% Total costs 6.0 8.8 Phase 3 Phase duration mo 42.0 7.0 Prob. success -5.9 17.1 Total costs €M 175.0 25.0 Prob. success % 70.0% Phase duration 6.1 9.0 Registrn. Phase duration mo 18.0 6.0 4.8 10.0 Total costs €M 5.0 1.0 Total costs Prob. success % 80.0% Prob. success -23.6 54.7 Sales growth Timing Delay to Launch mo Patients without special risks Total patient popn. K 1,000.0 100.0 Phase duration 5.0 10.2 & events Annual increase K Total costs 5.9 8.9 Target segment % 100.0% Peak patient share % 100.0% Prob. success -19.8 25.2 Current share % Phase duration 5.2 10.0 Adoption rate % 40.0% 10.0% Units Units/patient/year N 1.0 Total costs 7.4 Compliance rate % 100.0% Price Net price/Unit at L € 400.00 100.00 Prob. success -13.4 17.8 Inflation rate % Delay to Launch 7.4 Special risks & Generics & Event probability % 80.0% events biosimilars Expected date mo 21.2.2032 36.0 Total patient popn. 3.2 11.6 Volm decrease % 50.0% 10.0% Annual increase 7.4 Price decrease % 20.0% 10.0% Rate of impact % 50.0% 10.0% Target segment 7.4 Event 2 Event probability % 7.4 Expected date mo Peak patient share Volm decrease % Current share 7.4 Price decrease % Rate of impact % Adoption rate 4.1 9.6 Event 3 Event probability % Units/patient/year 7.4 Expected date mo Volm decrease % Compliance rate 7.4 Price decrease % -3.0 17.8 Rate of impact % Net price/Unit at L Event 4 Event probability % Inflation rate 7.4 Expected date mo Volm decrease % Event probability 5.2 11.8 Price decrease % Expected date 3.8 10.2 Rate of impact % Event 5 Event probability % Volm decrease 6.2 8.6 Expected date mo Price decrease 6.6 8.1 Volm decrease % Price decrease % Rate of impact 7.1 7.9 Rate of impact % Event 6 Event probability % Event probability 7.4 Expected date mo Expected date 7.4 Volm decrease % Price decrease % Volm decrease 7.4 Rate of impact % Price decrease 7.4 Event 7 Event probability % Expected date mo Rate of impact 7.4 Volm decrease % 7.4 Event probability Risk Price decrease % Rate of impact % Expected date 7.4 Event 8 Event probability % Expected date mo Volm decrease 7.4 Volm decrease % Price decrease 7.4 Price decrease % 7.4 Rate of impact % Rate of impact appetite Explicit assumptions & Sensitivity analysis of probability distributions key value/risk drivers 80.0 1,600.0 25.0 2,500.0 Preclinical Phase 1 Phase 2 Phase 3 Registrn. Phase 4 70.0 1,400.0 1,360.1 1,360.1 20.0 2,000.0 60.0 20.0 1,200.0 18.2 50.0 17.0 1,500.0 40.0 1,000.0 15.0 15.0 15.0 15.0 30.0 800.0 1,000.0 697.0 20.0 10.0 10.0 600.0 487.9 487.9 500.0 0.0 400.0 2012 2014 2016 2018 2020 2022 2024 2026 2028 2030 2032 2034 2036 2038 2040 2042 2044 2046 5.0 -10.0 0.0 2.8 200.0 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% -20.0 103.6 61.8 0.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 -30.0 0.0 0.0 -500.0 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 R&D Costs Net Sales G. Margin EBIT Net Profit Cash Flow NPV R&D Costs Net Sales Margin EBIT Net Profit Cash Flow NPV Value Vmean Vexp Vmed Vmin Vmax Risk threshold Automatic sales, P&L Cumulative forecasts Risk-adjusted R&D Monte Carlo analysis & cash flow forecasts over any period costs by phase/year of NPV, any P&L item ©KelvinStott2012
  • 69. Pharma R&D productivity crisis Fundamental issues & insights Pharma industry challenges Top 10 organizational issues Key elements of a complete solution A new fully integrated approach Concept Process Case study: Phase 2 project Conclusion & key messages ©KelvinStott2012
  • 70. Evaluate Evaluate risk-return risk-return profile of EVALUATE profile of EVALUATE current OPTIONS options & PROGRESS plan scenarios RISK-RETURN OPTIMIZATION Execute MAKE Select best updated EXECUTE option(s) DECISIONS DECISIONS plan and based on monitor risk-return progress profile ©KelvinStott2012
  • 71. Value & ROI Sales, P&L, cash flow forecasts Technical & Operational Commercial BD&L Financial regulatory value drivers value drivers value drivers value drivers PoS by phase R&D costs Target patients Licensing fees Discount rate Prob. approval R&D timelines Market share Dev. m’stones DSI, DSO, DPO Launch delay Adoption rate Sales m’stones Exchange rates Capex Dose & compl. Royalty rates Inflation rates COGS Net price Tax rates S&M costs New entrants G&A costs Generic impact Other factors ©KelvinStott2012
  • 72. Top-down External analysis advisors Bottom-up Internal analysis experts Mean Spread Skew Shape ©KelvinStott2012
  • 73. Value & ROI Sales, P&L, cash flow forecasts Technical & Operational Commercial BD&L Financial regulatory value drivers value drivers value drivers value drivers PoS by phase R&D costs Target patients Licensing fees Discount rate Prob. approval R&D timelines Market share Dev. m’stones DSI, DSO, DPO Launch delay Adoption rate Sales m’stones Exchange rates Capex Dose & compl. Royalty rates Inflation rates COGS Net price Tax rates S&M costs New entrants G&A costs Generic impact Other factors ©KelvinStott2012
  • 74. Value Upside risk (NPV) Expected value (eNPV) Probability Downside risk ©KelvinStott2012
  • 75. Risk Expected Value/ROI ©KelvinStott2012
  • 76. Value driver Uncertainty Project value/ROI ± risk Phase 3 PoS R&D timelines Phase 2 PoS Market share R&D costs Generic impact COGS ©KelvinStott2012
  • 77. Value & ROI Sales, P&L, cash flow forecasts Technical & Operational Commercial BD&L Financial regulatory value drivers value drivers value drivers value drivers PoS by phase R&D costs Target patients Licensing fees Discount rate Prob. approval R&D timelines Market share Dev. m’stones DSI, DSO, DPO Launch delay Adoption rate Sales m’stones Exchange rates Capex Dose & compl. Royalty rates Inflation rates COGS Net price Tax rates S&M costs New entrants G&A costs Generic impact Other factors ©KelvinStott2012
  • 78. Risk Risk appetite Expected Value/ROI ©KelvinStott2012
  • 79. Risk Risk appetite Expected Value/ROI ©KelvinStott2012
  • 80. Negative Positive data data Risk Expected Value/ROI ©KelvinStott2012
  • 81. EVALUATE EVALUATE OPTIONS PROGRESS Research Preclinical Clinical Approval Lifecycle & discovery developmt. developmt. & Launch managemt. MAKE EXECUTE DECISIONS DECISIONS ©KelvinStott2012
  • 82. Individual R&D projects (early or late-stage) Marketed products (branded or generic) BD&L opportunities (in & out-licensing deals) Entire portfolios (R&D or commercial) ©KelvinStott2012
  • 83. Pharma R&D productivity crisis Fundamental issues & insights Pharma industry challenges Top 10 organizational issues Key elements of a complete solution A new fully integrated approach Concept Process Case study: Phase 2 project Conclusion & key messages ©KelvinStott2012
  • 84. Phase 2 NCE for pancreatic cancer, new MoA, about to enter large Phase 3 trial Similar safety & efficacy profile vs competitor Positive eNPV BUT: current plan feels too risky Lack of clear dose response in Phase 2 Relatively low PoS (50%) in Phase 3 Significant uncertainty in potential market Key competitor already in Phase 3 ©KelvinStott2012
  • 85. Phase 3: $120(±10)m, 36(±6)mo, 50% PoS Approval: $15(±3)m, 12(±3)mo, 90% PoS Peak sales: $800(±300)m (50% within 24 mo) Competitor: 50% probability to launch in 2 yrs, reducing peak sales by 65(±10)% Generics: lose 80(±5)% sales after 12 yrs 10(±2)% COGS, 60(±5)% SG&A costs, 30% tax 8.0% discount rate ©KelvinStott2012
  • 86. Input Parameter Unit Default Scen. 1 Scen. 2 Scen. 3 Scen. 4 Scen. 5 Scen. 6 ±SD Accounting Tax Corp. tax rate % 30.0% 250.0 parameters Prob. deferral % WCap Inventory (DSI) days Acc/R (DSO) days Acc/P (DPO) days 200.0 Annual P&L / Cash Flow (millions) NPV Discount rate % 8.0% Global R&D Preclinical Phase duration mo Total costs $M Prob. success % 150.0 Phase 1 Phase duration mo Total costs $M Prob. success % End of Period Phase 2 Phase duration mo Total costs $M 100.0 Prob. success % Phase 3 Phase duration mo 36.0 6.0 Total costs $M 120.0 10.0 Prob. success % 50.0% 50.0 Registrn. Phase duration mo 12.0 3.0 Total costs $M 15.0 3.0 Prob. success % 90.0% Sales growth Timing Delay to Launch mo 0.0 without special Patients Total patient popn. K 800.0 300.0 risks & events Annual increase K Target segment % 100.0% Peak patient share % 100.0% -50.0 Current share % Uptake rate (t½) mo 24.0 Units Units/patient/year N 1.0 Compliance rate % 100.0% -100.0 Price Net price/Unit at L $ 1,000.00 2012 2014 2016 2018 2020 2022 2024 2026 2028 2030 2032 2034 2036 2038 2040 2042 2044 2046 Inflation rate % Special risks & Generics & Event probability % 100.0% events biosimilars Expected date mo 16/Apr/24 Volm increase % -80.0% 5.0% Net Sales Gross Margin EBIT Net Profit Cash Flow DCF Price increase % Impact rate (t½) mo 24.0 Comp. 1 Event probability % 50.0% Expected date mo 16/Apr/14 Volm increase % -65.0% 10.0% Price increase % 3,500.0 Impact rate (t½) mo 24.0 Comp. 2 Event probability % 3,078.6 Expected date mo Volm increase % 3,000.0 Price increase % 2,770.7 Impact rate (t½) mo Total P&L / Cash Flow (millions) Tech shift Event probability % Expected date mo Volm increase % 2,500.0 Price increase % Impact rate (t½) mo Event 5 Event probability % Expected date mo Volm increase % 2,000.0 Price increase % Impact rate (t½) mo Event 6 Event probability % Expected date mo Volm increase % 1,500.0 Price increase % Impact rate (t½) mo Event 7 Event probability % Expected date mo 1,000.0 Volm increase % 796.1 Price increase % Impact rate (t½) mo 557.2 557.2 Event 8 Event probability % Expected date mo 500.0 Volm increase % Price increase % 152.8 Impact rate (t½) mo Prodn costs COGS COGS per Unit $ (or % sales) % 10.0% 2.0% 0.0 Deprecn Depreciation/Unit $ Net Sales G. Margin EBIT Net Profit Cash Flow NPV (or % sales) % ©KelvinStott2012