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EU DTCA Ban: Effect on Patient Awareness & Influence on Prescribing

Carol Faverger Rosalyn Twite Director Director

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Context: Direct to Consumer Advertising in EU

Advertising non-prescription medicinesGenerally allowed, but with restrictions

Advertising Prescription medicinesProhibited as per The Advertising Regulations 1994, which implement EU

directive 92/28/EC

• Exceptions allow information on prescription only medicines (POMs) to be provided to the publice.g. reference materials (without product claims), human health and disease related statements with no direct orindirect reference to the product

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Crystal Ball Questions

Given DTCA of POMS in EU is banned, have we under-estimated the role of patients in prescribing decisions when conducting research?

Are patients being influenced by other means?

Are we reaching out to the correct decision makers when conducting our research?

Has the DTCA ban really led to less-informed patients in EU than in the USA?

In the future, should we be increasingly focusing on patients as decision makers ?

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Gauging the True Influencers: Method

KQH linked up with Research Now

PATIENTS PHYSICIANSUSA, GERMANY, UK, ITALY,

FRANCE, SPAINUSA, GERMANY, UK, ITALY,

FRANCE, SPAINTotal n =3000

n=500 per countryTotal n=240

n=40 per countryMust have been prescribed a drug

in the last 12 months GPs / PCPsOnline survey - by Research Now Online survey - by Research Now

Conducted January 2008 Conducted January 2008

Are patients discussing / just accepting?

Patient* Physician** Patient * Physician** Patient * Physician**

USA 56% 81% 47% 18% 4% 1%

GERMANY 72% 82% 30% 16% 3% 2%U.K. 66% 85% 31% 13% 6% 2%ITALY 68% 84% 36% 15% 4% 1%FRANCE 82% 80% 20% 16% 2% 4%SPAIN 83% 88% 21% 11% 3% 1%

* 500 patients per country interviewed J an '08** 40 PCPs per country interviewed J an '08

Other

Patient assumes drug is the most suitable and

accepts without discussion

Patient brings up possible alternatives

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Findings

• Majority across all countries are accepting without discussion

• Drs and patients agree that in over 80% of cases there will be no discussion

• Drs also state in over 80% of cases there is no discussion BUT patient responses flag up a greater willingness to mention alternatives (30 – 47%)

• EU patients self report as being more likely to accept without discussion (74% EU average vs 56% US)

• Awareness of alternatives significantly higher amongst US patients (47% vs 28% EU average)

If neither suggesting alternatives nor accepting ..

• Main concern was to learn more of side effects and efficacy

• Reluctant patients who are not keen on taking drugs

• Like to confirm medication choice with a Specialist

• Financial side mentioned

• Patients discuss with Pharmacist

• “Many patients have preconceived ideas about what product should achieve which results”

• Fear that physician will prescribe the cheapest possible alternative

Patient Influencers

Drs only: patients not referred to anything

USA 32% 70% 28% 78% 38% 70% 27% 25% 5% 10% 6% 20% 2%GERMANY 18% 65% 10% 60% 24% 85% 13% 33% 3% 37% 8% 18% 2%

U.K. 21% 95% 8% 68% 27% 93% 17% 15% 3% 40% 8% 17% 0%ITALY 23% 78% 11% 85% 26% 58% 20% 10% 3% 5% 6% 5% 7%FRANCE 8% 83% 5% 78% 14% 63% 8% 25% 1% 8% 5% 8% 2%SPAIN 12% 50% 5% 63% 15% 68% 11% 13% 4% 10% 6% 18% 13%

Patients - %age of total sample (asked only of those who may mention alternatives)Physicians - %age of total sample

Patients: From which of the following will you be aware of possible alternative drugs Physicians: Have patients referred to the following when discussing drugs with you

Other (Please specify)

Advertising in papers / magazines

/on TVThe

internet

Educational leaflets (eg leaflets in a

surgery / hospital)

Articles in papers /

magazines

A patient support group

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Findings

• Physician main sources: articles, internet & advertising

• Patient main sources: internet, articles & educational leaflets

• Advertising high in EU despite DTC Advertising ban?

• US patients self report that they use ALL sources of info more than EU

• Physicians report higher use than patients

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Other sources uncovered

• 18-20% of PCPs mentioned other sources

• Patients & PCPs in all countries mentioned friends & family as the main other source

• Pharmacists

• Patients consult with a specialist

• Other patients

Patients actively searching for information on drugs

On the internet

Via patient support groups

In the media

From educational

leaflets

Other (Please specify) None

USA 75% 8% 15% 34% 7% 18%GERMANY 72% 7% 22% 21% 8% 21%

U.K. 73% 6% 10% 22% 9% 20%ITALY 69% 6% 17% 34% 6% 18%FRANCE 55% 2% 4% 17% 6% 39%SPAIN 61% 5% 11% 27% 10% 27%

Asked of all n=500 patients per country, regardless of whether they discuss

Have you ever searched for information on drugs available for a condition you may have:

Findings

• An average of 24% of patients across all countries have not searched for information – very high in France (39%)

• Internet leads – average 66% across all countries

• Educational leaflets next most common - 26% average, helped by high proportions in US and Italy (34%)

• Friends & Family – AllSpecialists

Pharmacists Other patients

Awareness of Pharma Cos / Associations

55%

25%

48%

30%33%

25%

40%

34% 33%

24%

14%

22%

0%

10%

20%

30%

40%

50%

60%

USA GERMANY U.K. ITALY FRANCE SPAIN

Physicians Patients

Awareness of Pharma Companies

Most mentioned 2nd 3rd

Most mentioned 2nd 3rd

USA Merck Pfizer GSK USA Pfizer Merck Astra ZenecaGERMANY Bayer Novartis Roche GERMANY Hexal Pfizer BayerUK GSK Pfizer Astra Zeneca UK Pfizer GSK Astra ZenecaITALY Bayer Roche Pfizer ITALY Pfizer Novartis MenariniFRANCE Sanofi Aventis GSK Bayer FRANCE Sanofi Aventis Pfizer GSKSPAIN Bayer Pfizer Novartis SPAIN Sanofi Aventis Pfizer Novartis

ALL Bayer GSK Pfizer ALL Pfizer Sanofi Aventis GSK & Merck

PATIENTS: Pharma Cos patients aware of that provide information on drugs / diseases

Asked of all patients who were aware of Pharma Cos providing information on drugs / diseases. (Total sample n=834)

PHYSICIANS: Pharma Cos who have been behind any of the means of information referred to by patients

Asked of all physicians who were aware of Pharma Cos being behind any of the means of information referred to by patients

(Total sample n=86)

Is patient input growing?

More Less The same More Less The sameUSA 69% 2% 29% 75% 2% 23%GERMANY 68% 11% 21% 75% 2% 23%U.K. 62% 1% 37% 93% 0% 7%ITALY 44% 10% 46% 83% 0% 17%FRANCE 49% 3% 48% 76% 3% 21%SPAIN 45% 5% 50% 68% 2% 30%

* 500 patients per country interviewed J an '08** 40 PCPs per country interviewed J an '08

PHYSICIANS**: Do you think patients are more or less likely to discuss

different drug choices with you than they were 5 years ago?

PATIENTS*: Are you more or less likely to discuss different drug

choices with your doctor than you were 5 years ago?

Why patients are more likely to discuss different drug choices – The Physician Viewpoint

• More information available

• But are they better informed?

• Doubts on validity of source of information

• Searching for cheaper

alternatives

Why patients are more likely to discuss different drug choices – The Patient Viewpoint

• More information available

• Drs seen as more approachable

• Cost

• Increased concern about side effects

Drug most asked about in the last 12 months

Most mentioned 2nd 3rd

USA Champix Viagra Cialis

GERMANY Champix Viagra Simvastatin

UK Champix Simvastatin Viagra

ITALY Aulin ViagraLimpidex

(lanzopraxole)

FRANCE Champix Viagra Celebrex

SPAIN Analgesics Viagra Cialis

Which one individual drug have patients asked the most about in the last 12 months?

Asked of all n=40 physicians per country, Total n=240

Today

• Perceptions of Physicians and Patients vary

• EU DTCA ban less impact than expected?

• Patient apathy in France & Spain?

• Patients more likely to discuss alternative drug choices than 5 years ago

• Patients self-educating primarily using the internet, theneducational leaflets, then the media

• Side effects and cost driving patients search for information

Tomorrow – in the Crystal Ball …

• Patient use of support groups rises

• Greater collaboration between Physician and patient

• Increased focus in media on health related issues

• Patients more aware of cost considerations

• Increasing role of alternative medicine

• EU / USA awareness distinction narrows

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For more information, please contact . . .

Carol FavergerDirector

+44 (0)20 8090 5547carolf@keyquesthealth.com

Rosalyn TwiteDirector

+44 (0)20 8090 5549rosalynt@keyquesthealth.com