PM360 May 2011

PM360 COVER STORY: Unbranded DTC Advertising: Where's the ROI?

By Ross Thomson and Chuck McLeester

Build measurable action with unbranded campaigns that help patients stop avoiding thinking about their condition, start assessing their needs, and acknowledge that something needs to be done. Only then are they ready for a branded message.

HERE’S A ONE-QUESTION POP QUIZ. MULTIPLE-CHOICE.
Unbranded DTC advertising is: a. a market expansion strategy that only benefits the category leader. b. a regulatory inevitability that will be the death of DTC. c. a waste of money. d. a first step toward engaging patients with your brand and generating a measurable ROI. e. None of the above.

If you answered anything other than d, read on. Unbranded advertising is not what you think. It has the power to bring patients into your brand’s franchise in a cost-effective way— patients who might not otherwise pay attention to your message.

Estimates have put the ROI on branded DTC advertising at about 2:1.¹ Properly planned, executed, measured and managed, unbranded advertising can do much better. More on the ROI metrics later, but first, here’s why unbranded advertising can work for you whether you manage a new, first-in-class brand or a later entrant to an established category.

AWARENESS ISN’T ENOUGH
Branded DTC is based on the traditional consumer marketing assumption that brand awareness leads to increased sales; that awareness leads directly to action. The assumption is that, just as hearing about a consumer brand on TV entices people to buy that brand at the supermarket, hearing about a pharmaceutical brand will entice them to ask for it at the doctor’s office.

Except that it doesn’t work that way. The 2006 CommonHealth linguistic analysis of DTC advertising’s influence on physician-patient communications² confirms that only a small percentage of the target consumer population will take any action at all based on “awareness” efforts.

Unbranded advertising, however, can be effective in moving consumers to action, but you have to use it properly. Simply increasing awareness of a disease state is not enough. There’s a big step between awareness and action in consumer behavior— and that step is acceptance. Consumers need to understand and accept their need for treatment before they take action about a specific brand. Telling them about your brand before they’ve internalized the need for it is futile. That’s where unbranded advertising can be most effective.

BUILDING THE ACCEPTANCE BRIDGE
Unbranded advertising is the first step in bridging the gap between awareness and action. It can get prospects to raise their hands for information about a disease state and start the conversation. Then you can use that conversation to overcome barriers to acceptance, barriers like misinformation, apathy, and avoidance. Once they’re engaged and moving toward acceptance, you can insert your brand into the conversation.

A classic osteoporosis campaign offers a textbook example of using unbranded advertising to break down the barriers to acceptance. Research showed that newly post-menopausal women in the “forever-young” baby boom generation did not personalize their risk for osteoporosis, but rather, viewed it as something that their mothers or elderly aunts got. Getting them to pay attention to a brand message was useless. But unbranded advertising was successful in starting a dialog that helped these women accept their risk for the disease.

Print ads in targeted women’s magazines depicted “woman-to-woman” conversations about osteoporosis and offered a free booklet, Osteoporosis: Could you be at risk? It was a simple value proposition with no mention of a brand, and yet it evoked enough curiosity to engage prospects to find out more. With the booklet, respondents received an information package that addressed the barriers to acceptance and guided the prospects along the path to action.

CLOSING THE ROI LOOP
The package also included information on the brand and an incentive for the first month’s prescription—making the unbranded campaign measurable from initial response all the way through to Rx. So, knowing how much a patient is worth to your brand, you can calculate ROI based on your cost per response to the unbranded communication and your rate of conversion to prescription.

MAKING UNBRANDED WORK FOR YOUR BRAND
Using a combination of online and offline vehicles, you can stimulate consumers to assess their risk, find out more, and begin the engagement. Once they respond, by requesting information or going to your website, you need to carefully manage their journey toward acceptance. Don’t take them directly to Brand.com—they’re not ready for that. Instead, create an online resource where they can explore and assess their potential risk. Make it easy for them to link to brand information when the time is right.

As you manage this dialog, it’s important to understand that acceptance is not a single event, but rather a process, with three steps along the path to acceptance: Avoidance, Assessment, and Acknowledgement.³

WHO, ME?
Avoidance can be rooted in misinformation, apathy or denial. Unbranded advertising is your only opportunity to engage prospects when they are in this state of mind. It’s pointless to try to get prospective patients to pay attention to a brand message while they’re in this phase. You need to break through barriers of skepticism and misinformation before you can move a person to consider that she or he may be at risk for a specific condition or in need of a particular therapy.

Brand-specific messages are irrelevant to prospects at this stage. They may, in fact, be counterproductive, viewed as nothing but sales pitches. On the other hand, unbranded messages can have the cachet of information useful to oneself or a loved one. And this value proposition can start an interaction with the prospect, a relationship that allows you to insert the brand at the appropriate time.

EXPLORING THEIR OPTIONS
The Assessment phase is where the barriers to Acceptance begin to break down. Prospects realize their limitations, explore their options, and begin to see new possibilities. Here’s where they become receptive to a brand message—a message that provides hope and empowerment. Here’s where inserting the brand into the conversation makes sense for both the consumer and the brand. The Assessment phase is where you need to bridge the delicate balance between unbranded disease information that helps define the problem and brand information that presents a solution.

GETTING TO ACKNOWLEDGEMENT
In the osteoporosis example, presenting patients with facts about the disease helped them personalize their risk. In conjunction with disease information, they received tips for talking with their physicians, brand information, and an incentive toward their first Rx—a clear roadmap to Acceptance that let them close the loop on Avoidance, Assessment and Acknowledgement.

WHERE’S THE ROI?
Here are two ways you can prove the ROI of this approach:
1. Isolated market testing.
2. Assessing patient value vs. patient acquisition cost.

ISOLATED MARKET TESTING
Pick a group of markets and pilot your unbranded effort for an 8- to 12-week period. Measure new prescriptions in those markets from the onset of the campaign through 3 months post-campaign (the extended time gives patients a chance to evaluate their situations and see their physicians). Compare the test-period NRxs against NRxs in non-test markets for the same period, and against NRxs in the same markets for prior periods. Did your brand grow more (or lose less) in the test markets vs. the control markets? Calculate and extrapolate the incremental revenue from the test markets and compare it with the cost of rolling out the campaign. The analysis will show your ROI from the unbranded effort.

If there are other variables at play, factor them into a regression analysis to determine their relative weight against the unbranded DTC. In a recent (proprietary) campaign analysis, DTC was one of several factors positively correlated with sales in the test markets at a statistically significant level. The advertising drove double-digit ROI.

PATIENT VALUE VS. PATIENT ACQUISITION COST
This methodology compares a patient’s lifetime value to the brand against the cost of acquiring a new patient. It requires that you know the average length of therapy in days for your brand and the average wholesale cost of your brand per day.

Monitor each key metric in your pilot markets: cost to get a response, rate of conversion of responses to Rxs, and cost to acquire a patient. Managing your online or offline DTC efforts to the cost-per-response requires ongoing tweaking to the media buy, but ongoing adjustments can yield improvements of 70% or more in cost-per-response. Conversion to Rxs takes longer to measure, but you can do it with a combination of incentive redemptions and incremental Rxs in the test market (as measured above).

THE BOTTOM LINE
Unbranded advertising can give your brand an advantage when it comes to reaching people who are not yet ready to take action. It allows you to start a conversation with a prospect and then insert your brand into the conversation after you’ve led the prospective patient through the assessment phase— when they’ve moved beyond avoidance and denial and they’re ready to take action.

REFERENCES
1. See, for example, Bob Ehrlich’s DTC Perspectives at www.dtcperspectives.com.
2. CommonHealth. 2006. “Consumer-directed promotion of regulated medical products.” Released by the US Food and Drug Administration under a Freedom of Information Act request for Part 15 Public Hearing Docket No. 2005N-0354, EMC 590.
3. These are defined in the Catalyst Brand Acceptance Model developed by Talya Miron-Shatz.

Ross Thomson (rthomson@roskahealthcare.com) is executive vice president and chief creative officer and Chuck McLeester (cmcleester@RoskaHealthcare.com) is senior vice president for planning, metrics and analytics at Roska.