PM360 March 2010

DTC FOCUS

Seeing Consumer Promotion Opportunities in High Definition
By John Moran and Tim Hughes, IMS Americas Innovation Lab

Successful promotional spending can depend on factors that vary significantly by geography. Integrating a much wider range of local prescriber, patient, and payer data provides new, actionable findings.

Costly primary research and incomplete promotion modeling can only loosely explain treatment behavior and consumer consumption patterns. A creative new solution reveals these in high definition so that strategies can be developed to reach patients with specific indications and physicians with high prescribing potential.

The question of how much to invest in direct-to-consumer (DTC) promotion—if indeed any investment is advisable —never has been easy to answer. But, with the influence of managed care on treatment choices, product managers with brands in the growth phase of the lifecycle are at an even greater loss. Will the local reimbursement situation render DTC ineffective in converting patient awareness into brand consumption? And, for products that have matured to the point of gaining new (and often unrelated) indications, should surgically precise consumer outreach be used to build select indications, and if so, which ones?

Data indicates that mass media spending (TV, print, radio) will decline approximately 9%, or $400 million, for the largest brands in 2009. Though the expansion of alternative consumer channels such as Internet advertising and social networking sites are responsible for some of the shift in dollars, it is also likely that marketers are rethinking their consumer promotion budgets given the realities of payer reimbursement plans.

The following article outlines a tool that managers can use to maximize the return on their investment in consumer promotion. It makes patient outreach more selective, while also supporting the most relevant physicians in their treatment decisions.

Calculating DTC Spend Traditionally
Typically, determining how much to spend on DTC promotion for a brand that has no DTC track record involves several steps:

1. The first step is to assess historical DTC usage and spending by other brands in the therapy area or in related therapy areas to serve as a benchmark. Usually, this involves identifying appropriate analog brands and collecting spending and market share data over 24 months.
2. Next, one must calculate how select analog products responded to DTC promotion at different spending levels and over a several-year horizon.
3. Models of similar spending levels are then created for the brand being considered for DTC. Channel mix and spending levels are then optimized to achieve the brand’s 12- to 24-month sales and share forecasts.
4. Primary research with patients and physicians is also used to help assess attitudes toward the brand and how advertising can be used to optimize the positioning.
5. Finally, financial modeling and ROI analyses are conducted to gain investment approvals.

Brands with DTC history are assessed in a similar way, but the decision to continue the investment relies more heavily on the brand’s historical DTC response curve and the expectation for change in its competitive set.

A High-Definition Alternative
The method just noted is sound for developing overall spending levels at the national level. However, factors that can affect the success of promotional spending—formulary position, key opinion leader (KOL) influence, patient demographics, and disease prevalence—can vary significantly by geography. Fortunately, a new tool has been developed to identify consumer promotion opportunities at the MSA level. It integrates healthcare data in a state-of-the-art fashion and works equally well for brands with and without DTC experience.
An MSA-based system of business analysis is not new, but integrating a much wider range of local prescriber, patient, and payer data is new. The approach involves studying physician prescribing behavior and patient consumption patterns in light of local market formularies and co-pay levels. The approach has two significant advantages over subjective primary research: It is more cost-effective, and the findings are also more concrete and actionable.

This analysis of consumer outreach opportunities is based on four key principles:

1. Consumer outreach is more productive when current patients and prospects are pre-screened for relevance to the brand.

   Using today’s robust anonymized patient-level data (APLD), integrated with medical claims information, disease sufferers can be de-identified and linked to their physicians, either directly through the patient’s drug consumption (filled prescriptions) or indirectly through their comorbidities (prescriptions and diagnoses contained in medical claims data). Physicians active in a given disease area or product class can then be readily identified and mapped according to MSA or other local geographies, such as sales force territories and districts. This type of mapping can now be done for product indications, not just brands, giving marketers and sales forces a “high definition” view of the patients most relevant to their brand’s success. Companies can then proceed with indication-specific segmentation, positioning, and field deployment.

   A tool that analyzes longitudinal APLD and claims data has the advantages of offering timely insights as well as the ability to see fast-breaking trends. Maps of indication-specific patients (de-identified) and physicians can be updated weekly or monthly to track a brand’s effectiveness in reaching these relevant customers. DTC events can then be measured in almost real time to determine the impact of select channels on the behavior and consumption of the prime customer base.

2. Generally, assessing consumer outreach through primary research is inconclusive; robust secondary data is required to reveal opportunities of true value.

   The data used for the analysis is almost entirely secondary data: anonymous patient-level data, medical claims, health-plan and managed-care data, and promotion audits (which include the company’s prescriber-level detailing and sampling data). Message recall statistics and metrics of a customer’s value can also be incorporated. A brand’s call file or other market research on physicians can also be leveraged to enhance the value of the analytics. Figure 1 (shown on page 44) shows how advanced healthcare data are joined to develop new and actionable insights.

   The secondary data sources mentioned contain hundreds of thousands of physicians and in some markets more than one million anonymized patients; in contrast, a typical primary market research project will involve only a few hundred physicians at most. Secondary data thus provides actionable insights into objective, observable behavior. Secondary data also has the advantage of being dynamic and easily adaptable to research new areas of opportunity. Primary market research questions, on the other hand, are static.

3. With the expansion of consumer channels, brand teams now have the ability to allocate their investment in consumer/patient promotion based on local, indication-specific patient densities and reimbursement status.

   An example of this is found in Figure 2 (opposite), which is a prescriber opportunity view for a particular brand indicated for Chronic Obstructive Pulmonary Disease (COPD). By joining anonymized patient-level data, diagnosis information from medical claims data, and prescription counts, a picture of the prescribing landscape and densities of indication-specific de-identified patients was developed for Q3 2009. This national view shows which groups of high-potential physicians treat the bulk of the indication-specific de-identified patients. While this view is national, however, it is easily replicated at an MSA or sales territory level.

   Brand X was written by 42,395 prescribers or 17.8% of all prescribers who made a COPD treatment decision during Q3. A treatment decision is defined as one of the following: a new therapy start (patient naïve to any previous treatment), switching the patient’s therapy, restarting therapy after at least a
   12-month lapse, or adding-on therapy. These treatment decisions are considered to be a new-to-brand Rx or NBRx. This information is obtained via LRx data (longitudinal anonymized patient-level prescription data). Patients for whom refills were written are not included in treatment decisions, though that data are available and can be easily integrated and leveraged for additional analytics.

   Brand X decision makers are divided into healthcare practitioner (HCP) preference groups. In this case, three HCP Groups were created, with HCP Group A having the highest usage of Brand X (at least 25% of their NBRx going to Brand X). HCP Group B had between 10% and 24% of their NBRx for Brand X, and HCP Group C had less than 10% for the brand (physicians with no treatment decisions were excluded). Penetration and density of prescribing opportunities are identified from this breakout.

   These findings demonstrate that even though HCP Group C utilizes Brand X infrequently as a percentage of patients seen, they see more patients on
   average compared to the HCP Groups A and B. Drilling further into HCP Group C with the myriad of data available through secondary data sources can identify opportunities for a surgical DTC campaign that can target patients with the characteristics of those in HCP Group C and ultimately increase brand usage among their physicians.

   Prescribers with high densities of COPD patients can be further evaluated using a variety of other metrics that can be combined with patient characteristics such as average co-pay, plan type, patient age, gender, ethnicity, channel and outlet type, comorbidities, and ZIP Code used to map highest potential patients for
   consumer outreach. The breadth of these data greatly exceeds even the best primary market research.

   If you are advertising one indication for a multi-indication drug, the ability to target DTC to the geographies in which these high-prescribing physicians practice can reduce DTC spending and improve its effectiveness. Until now, advertising could only be implemented nationally, without regard to the geographic densities of indication-specific patients. What is more, through the use of these secondary data sources, the results of the campaign can be tracked and reported quickly in actual sales, not just Gross Rating Points.

4. Coordinating consumer outreach with physician promotion further enhances the impact of promotional spending.

   Customer Value Metrics Research by IMS indicates that physicians who are aware of and consulted on a company’s consumer outreach efforts respond more strongly to personal promotion and have stronger relationships with the company. Understanding the company’s message to patients about a particular product helps the physician respond better to the patient’s inquiries.

   Sales forces that alert physicians to upcoming consumer programs tend to rate higher on relationship and value delivery. By identifying physicians who see a higher proportion of indication-specific patients, companies can better direct their messaging about consumer events to build trusted advisory relationships with physicians. Secondary data can then be used to continually track and evaluate the results of such targeted messaging.

Conclusion
Given today’s difficult economic reality, brand managers are tasked with finding ways to do more with increasingly smaller budgets. Leveraging robust, secondary data at the anonymized patient level is a cost-effective solution that delivers timely and actionable insights.

Data available at the MSA or sales region level can be analyzed to identify key characteristics of patients—and, more important, their physicians—so a surgical DTC campaign or other consumer spend will be more effective. The results of the spend can be reported in almost real time, allowing the brand manager to adapt the campaign as necessary and quickly roll it out to other geographies with similar patient and prescriber characteristics. The high-definition insights from this approach can easily be implemented within a brand’s overall strategy and can give brand managers an edge in a challenging economic environment.

John Moran is the Director of the Americas Innovation Lab at IMS Health. Tim Hughes is a Senior Statistician there. The newly formed Innovation Lab at IMS is combining healthcare data and methodologies to generate novel approaches for seeing and responding to customer needs. For more information, please contact John Moran at jmoran@us.imshealth.com