3. Adherence to long-term therapy for
chronic illnesses in developed countries
averages 50%. In developing countries, the
rates are even lower1
1. WHO: adherence to long-term therapies: Evidence for action. 2003
4. 1. IMS Institute for Healthcare Informatics – Advancing the responsible use of medicines:
Applying levers for change, Oct 2012
The health spending that can be
avoided in this way amounts to 8%
of total annual health expenditures
worldwide1
"Responsible" meds use can save $500B/year globally
More than half ($269B) can be
gained through improved patient
adherence, according to the
report1
10. The evidence to date
Patient adherence
interventions / support
11. Inconclusive findings - but acknowledged scarcity of evidence
Haynes et al, Interventions for enhancing medication adherence. Cochrane database of systemic reviews 2008, Issue 2
Authors’ conclusions:
“For short term treatments, several quite simple interventions increased adherence
& improved patient outcomes, but the effects were inconsistent from study to study.”
“For chronic conditions, interventions are mostly complex and not very effective.”
Short term treatments
- 5/10 interventions improved adherence
- 4/10 interventions improved clinical outcomes
Long-term treatments
- 36/83 (43%) interventions improved adherence
- 26/83 (31%) interventions improved clinical outcomes
15. Overview
• A scalable intervention programme
designed to increase adherence to
asthma preventative medication
• Programme developed in conjunction
with the University of Auckland and
supported by Vodafone
• Programme conducted as part of a
randomised controlled trial (RCT)
• Programme comprises 18 week text
message package tailored to the
individual’s illness perceptions &
medication beliefs
A study targeting patient beliefs to improve adherence
16. Improved adherence in asthma intervention group
Adherence% Average adherence over all time points was 43.2% in
control group v’s 57.8% in intervention group
Keith J. Petrie, 2012, A Text Message Programme Designed to Modify Patients’ Illness and Treatment Beliefs improves
Self-Reported, Adherence to Asthma Preventer Medication, British Journal of Health Psychology 17, 74-84.
17. Personalised programmes can deliver lasting behaviour change
0
10
20
30
40
50
60
70
Baseline 6 Weeks 12 Weeks 18 Weeks 6 Months 9 months
Control Intervention Group
AverageAdherence%
Intervention ceases at 18
weeks, adherent behaviour
continues
Average adherence over all time points was 43.2% in
control group v’s 57.8% in intervention group
Keith J. Petrie, 2012, A Text Message Programme Designed to Modify Patients’ Illness and Treatment Beliefs improves
Self-Reported, Adherence to Asthma Preventer Medication, British Journal of Health Psychology 17, 74-84.
19. HCP’s differentiate brands with patient support programme
Specialist physicians
surveyed - 61% stated the
availability of the patient
support programme would
likely impact on their
choice of treatment
Independent market research 2013 – data on file
20. Patient support programme
Patients with wet age related macular degeneration (AMD)
12 month patient support. Interventions
included:
- seminars
- nurse calls
- welcome packs for carers & patients
- Self monitoring tools
- DVD’s & Audio
Strategy
1. Empower patients to take control
2. Create a patient support programme that is valued by patients and is recognised
by HCP’s
3. Differentiate product from its competitors
Atlantis Healthcare - Data on file
Programme running for 5 years due to positive commercial return
21. Commercial return prolific
• 8 fold decrease in drop out – 3% of patients on the program
discontinued treatment versus 24% not on the program
• Patients on the program have on average 2.5 additional scripts
per annum
• 3,000 patients enrolled
• ROI = 941%
Average number of treatments per time period
n 3 mths 6 mths 9 mths 12 mths 15 mths
Non PSP 2645 2.78 4.30 5.38 6.22 7.00
PSP 316 3.20 5.52 7.21 8.70 10.38
Atlantis Healthcare - Data on file
22. The ability to develop value propositions
Roebuck C, Liberman J, Gemmill-Toyama M et al. Medication adherence leads to lower health care use
and costs despite increased drug spending. Health Affairs, 30, no.1 (2011):91-99
Therapy area Return on investment
Chronic heart failure 8.4 : 1
Hypertension 10.1 : 1
Diabetes 6.7 : 1
Dyslipidaemia 3.1 : 1
Link to KAM model and reduced resourcesHow many have patient centric activities within brand campaign plan?How many have an adherence strategy within their brand strategies?Do you think patient adherence programmes are a good investment? Yes, no, don’t knowThe link between PSP and adherence
£300m = £90m unused meds + £110m returned to pharmacy + £50m disposed of by care homes
£162m lost revenue / year - what is it costing you?
Interventions – counselling, written information & personal phone callsLong-term – information, reminders, self monitoring, family therapy etc.Less than half the studies small in numbers and therefore not poweredself report
The Service Delivery and Organisation Network comprises a group of NHS organisations which supportresearch, evaluation and innovation to enable managers to improve and develop services.
- CHF- Personalisation is all about delivering info. that is specific to your beliefs
Modelled ROI forecasts based on the above outcomes within asthma for certain companies
“85% of GP’s more likely to prescribe a treatment with a PSP v’s one without when all other things considered equal”
Still going – 5 years on
Study based on 135,000This US based study to a financial approach to the issue of adherence and the its impact on subsequent healthcare costs using a return on investment approach. Essentially the study answers the following question. ‘For every additional dollars worth of medication ingested by a patient what is the impact on healthcare utilisation costs?’ Across all 4 disease reviewed all four came back with a positive return on investment for increasing adherence (and the subsequent higher investment in medicines). In CHF for every additional dollars worth of medicines taken by the patient there was an associated $8.40 saving in reuced health utilisation (reduced hospitalisation rates and length of time spent in hospital) emergency dept visits etc.
97% needs to be replaced by 89% and the 3% needs to be replaced by 1%
Support & interventions must be targeted towards the intentional non–adherence issues (perceptions/health beliefs) and the non-intentional issues (practical barriers)Support programmes need to be personalised – tailored messages based upon patient behavioursSupport programmes can deliver commercial ROI but avoid the common pitfalls