Patient Compliance in Psychiatry - From Patient Acquisition to Patient Retention

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Publication Date: 2004-12-15

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Generic saturation coupled with a poor R&D pipeline is forcing pharmaceutical companies to seek alternative ways of maintaining revenue growth in the ever-competitive psychiatry sector. Surprisingly, despite being long recognized as a costly problem, interest in patient compliance is only just gaining momentum and effective patient compliance programs have yet to become standard practice.

Scope

Analysis of the prevalence of noncompliance in schizophrenia, bipolar disorder and depression with an overview of compliance improving strategies

For these three disorders: discussion of general and side-effect specific reasons for noncompliance

Insight into the actions taken by care managers of noncompliant patients

In-depth analysis of the perceived usefulness of approaches to tackle noncompliance and the influence of education sources

Report Highlights
Players in the schizophrenia, bipolar disorder, and depression markets lose millions of dollars in drug sales annually due to noncompliance. Capturing this lost revenue is becoming ever important as the return on investment of traditional lifecycle management strategies is dwindling.

Pfizer and Eli Lilly have both implemented large compliance programs in psychiatry, which have been well received by the medical community. The popularity of these programs can be attributed to a patient-focused design, which, among other benefits, has served the companies' profile among end-users.

Ultimately, education to patients is a free service provided by companies. If shown to improve treatment outcomes in controlled studies, companies would be in a stronger position to convince payers and regulatory bodies to advocate their brands over generics.

Reasons to Purchase

Understand the key reasons causing noncompliance in schizophrenia, bipolar disorder, and depression and the actions taken by therapists

Benchmark your own patient compliance programs to those that have already been conducted by other companies

Optimize the communication of your compliance messages by recognizing the most influential sources of information for these patient groups

ABOUT DATAMONITOR HEALTHCARE - page 2
- About the CNS pharmaceutical analysis team - page 2
CHAPTER 1 EXECUTIVE SUMMARY - page 3
- Scope of the analysis - page 3
- Summary - page 5
- Key metrics - page 6
- Study methodology and sample details - page 8
CHAPTER 2 OVERVIEW OF PATIENT COMPLIANCE IN PSYCHIATRY - page 18
- Definition of patient compliance - page 18
- Frequency of noncompliance across psychiatry indications - page 18
- Epidemiology of schizophrenia - page 20
  - Overview - page 20
  - Prevalence - page 21
  - Diagnosis and treatment rates - page 21
  - Compliance rates - page 21
- Epidemiology of bipolar disorder - page 24
  - Overview - page 24
  - Prevalence - page 25
  - Diagnosis and treatment rates - page 25
  - Compliance rates - page 25
- Epidemiology of depression - page 27
  - Overview - page 27
  - Prevalence - page 27
  - Diagnosis and treatment rates - page 28
  - Compliance rates - page 29
- Cost of noncompliance to pharmaceutical companies - page 31
- Strategies shown to improve compliance - page 32
  - Treatment-related - page 32
    - Minimize drug side effects - page 32
    - Drug regimen - page 32
    - Reminder or compliance packaging by manufacturer - page 33
    - Number of doses per day - page 34
    - Unit dose convenience packs - page 34
    - Pill boxes - page 35
    - Drug delivery systems - page 35
  - Clinician-related - page 36
    - Patient counseling - page 36
    - Patient education and psychotherapy - page 36
    - Communication training - page 37
    - Patient education and compliance monitoring - page 38
    - Home visits - page 38
  - Patient related - page 39
    - Patient-skill building "Medication chart" - page 39
    - Reminders by telephone - page 39
    - Clinic and telephone visits with written correspondence - page 40
    - Electronic devices - page 40
  - Family support - page 40
  - Support group sessions - page 41
- General considerations for patient compliance programs - page 41
  - Improving relationships with end-users makes good commercial sense - page 41
  - Interventions must be highly relevant to the individual - page 41
  - Information needs to be given throughout the treatment course - page 42
  - Specific European opportunities - page 44
    - Acceptance of depot formulations beyond schizophrenia - page 44
    - Patient education through Health professional led local meetings - page 44
  - Summary - page 45
CHAPTER 3 PATIENT COMPLIANCE IN SCHIZOPHRENIA - page 46
- Market overview - page 46
- First line treatment of schizophrenia - page 48
- Reasons for noncompliance in chronic schizophrenia - page 49
  - General reasons - page 50
    - Lack of insight and drug side effects are key to noncompliance - page 50
    - Perceived treatment success suggest a need for education prior to and during drug treatment - page 54
  - Side effect-specific reasons - page 55
    - Weight gain is a big problem - page 58
    - BMS needs to emphasize in Abilify's marketing messages that it causes minimal weight gain compared to rivals - page 59
    - Care managers do not normally warn patients about side effects - page 59
    - Patients are equally likely to be noncompliant due to a fear of a side effect as they are due to the actual occurrence of a side effect - page 60
    - Side effect management programs can improve patient retention - page 61
    - Case Study: Lilly's 'Solutions for Wellness' program - page 62
- Actions taken for noncompliant schizophrenia patients - page 63
- Approaches to improving compliance in schizophrenia - page 64
  - Drug approaches - page 66
    - There is a need for more atypical depots - page 66
    - Pain at site of injection is a problem for patients taking depots - page 68
  - Non drug approaches - page 70
    - A good therapeutic alliance is key - page 71
    - Directly observed therapy is good in theory but problematic in practice - page 72
    - Involving the family is challenging but effective - page 72
  - Influence of educational sources - page 74
    - The therapist is the best source of information on treatment compliance - page 76
    - Websites and DTC advertising are good sources of general information but are not so good for providing specific drug compliance education - page 76
    - Patient education should be given at different stages of treatment and tailored to the individual - page 77
    - Case study: Lilly's 'Meaningful Day' educational program - page 77
- Datamonitor conclusions and recommendations - page 79
CHAPTER 4 PATIENT COMPLIANCE IN BIPOLAR DISORDER - page 81
- Market overview - page 81
- First line treatment of bipolar disorder - page 82
- Reasons for noncompliance in bipolar disorder - page 84
  - General reasons - page 84
  - Side effect-specific reasons - page 86
- Actions taken for noncompliant bipolar disorder patients - page 88
- Approaches to improving compliance in bipolar disorder - page 90
  - Drug approaches - page 90
    - Lessening the burden of oral pills is a good strategy - page 90
    - Combination pills offer few advantages - page 91
  - Non drug approaches - page 92
    - Leading players provide free compliance tools such as mood diaries - page 93
  - Influence of educational sources - page 95
    - Websites are not viewed as useful sources of information - page 96
    - The trend is to support health information sites - page 97
    - Public information is beneficial but key messages must be unrelated to product-specific marketing - page 98
- Datamonitor conclusions and recommendations - page 99
CHAPTER 5 PATIENT COMPLIANCE IN DEPRESSION - page 101
- Market overview - page 101
- First line treatment of depression - page 102
- Reasons for noncompliance in depression - page 103
  - General reasons - page 103
    - A multitude of reasons are responsible for noncompliance in depression - page 104
    - Patients will be noncompliant whether the drug does or does not work - page 104
  - Side effect-specific reasons - page 105
    - Sexual dysfunction is a leading cause of noncompliance in the US and EU - page 107
    - Case study: GSK's Wellbutrin-XL successfully promoted as the only once-daily antidepressant without sexual side effects - page 108
    - Media coverage of the SSRI suicide risk story increased noncompliance - page 109
- Actions taken for noncompliant depression patients - page 110
- Approaches to improving compliance in depression - page 111
  - Drug approaches - page 111
    - Reformulation is not the way to go in the US depression market - page 112
  - Non drug approaches - page 113
    - A strong therapeutic-alliance and patient education are key means of improving compliance in depression - page 113
    - Collaborations with patient advocacy groups are recommended - page 116
    - Esteve launches innovative 'PatientFeedback' tool to improve communication between depression patients and their therapists - page 117
  - Influence of educational sources - page 118
    - DTC advertising is not practical as a compliance improving tool - page 120
    - Case study: Pfizer's 'Rhythms' patient education campaign was an effective patient compliance strategy - page 123
    - Compliance aids are less accessible on depression information websites - page 124
    - Effective disorder information leaflets need to be clear, informative and stimulating - page 125
    - CME programs targeted to healthcare providers offer greater coverage of education - page 126
- Datamonitor conclusions and recommendations - page 127
APPENDIX A - page 129
- Bibliography - page 129
- Websites - page 143
APPENDIX B - page 145
- Sample details - page 145
  - First line treatment - page 145
  - General details - page 151
- Physician research methodology - page 152
- Study questionnaire - page 153
APPENDIX C - page 185
- About Datamonitor - page 185
  - About Datamonitor Healthcare - page 185
  - About the CNS analysis team - page 186
  - Key therapy team members - page 187
    - Lynda Lynch, Director CNS - page 187
  - Disclaimer - page 188

List of Tables
Table 1: Key schizophrenia epidemiology, 2004 - page 6
Table 2: Key bipolar disorder epidemiology, 2004 - page 7
Table 3: Key depression epidemiology, 2004 - page 8
Table 4: Sample details for the Stakeholder Insight: Patient Compliance in Psychiatry Survey, 2004 - page 9
Table 5: Key schizophrenia epidemiology, 2004 - page 20
Table 6: Key bipolar disorder epidemiology, 2004 - page 24
Table 7: Key depression epidemiology, 2004 - page 27
Table 8: Percentage patient compliance versus number of doses per day - page 34
Table 9: Side effect profile comparison of key antipsychotics - page 58
Table 10: Sample details of the Patient Compliance in Psychiatry Survey, 2004 - page 151

List of Figures
Figure 1: Noncompliance rates across psychiatric disorders, 2004 - page 19
Figure 2: Lamictal's fold-out compliance packaging - page 33
Figure 3: First line monotherapy for schizophrenia, 2004 - page 48
Figure 4: Reasons why schizophrenia patients are noncompliant, 2004 - page 50
Figure 5: Medication adherence rates at 12-month follow-up for outpatients filling prescriptions for typical and atypical medications in a veteran affairs health care system - page 52
Figure 6: Noncompliance due to the 'fear' versus 'actual occurrence' of a side effect in schizophrenia in the US, 2004 - page 55
Figure 7: Noncompliance due to the 'fear' versus 'actual occurrence' of a side effect in schizophrenia in Japan, 2004 - page 56
Figure 8: Noncompliance due to the 'fear' versus 'actual occurrence' of a side effect in schizophrenia in the EU, 2004 - page 57
Figure 9: Actions taken for noncompliant schizophrenia patients, 2004 - page 63
Figure 10: How well drug formulations improve compliance in schizophrenia, 2004 - page 66
Figure 11: Quarterly sales of Risperdal Consta in the EU and US, 2002-2004 - page 67
Figure 12: How well non drug approaches improve compliance in schizophrenia, 2004 - page 70
Figure 13: The effect of patient education sources on treatment compliance in schizophrenia, 2004 - page 75
Figure 14: First line monotherapy for bipolar disorder, 2004 - page 82
Figure 15: First line 2-drug combination therapy for bipolar disorder, 2004 - page 83
Figure 16: Reasons why bipolar disorder patients are noncompliant, 2004 - page 85
Figure 17: Noncompliance due to the 'fear' versus 'actual occurrence' of a side effect in bipolar disorder in the US, 2004 - page 86
Figure 18: Noncompliance due to the 'fear' versus 'actual occurrence' of a side effect in bipolar disorder in Japan, 2004 - page 87
Figure 19: Noncompliance due to the 'fear' versus 'actual occurrence' of a side effect in bipolar disorder in the EU, 2004 - page 88
Figure 20: Actions taken for noncompliant bipolar disorder patients, 2004 - page 89
Figure 21: How well drug formulations improve compliance in bipolar disorder, 2004 - page 90
Figure 22: Quarterly sales of Symbyax in the US, 2004 - page 91
Figure 23: How well non drug approaches improve compliance in bipolar disorder, 2004 - page 93
Figure 24: Eli Lilly's downloadable Mood Diary program for the PC - page 94
Figure 25: The effect of patient education sources on treatment compliance in bipolar disorder, 2004 - page 96
Figure 26: A bipolar disorder information website sponsored by GSK - page 98
Figure 27: First line monotherapy for depression, 2004 - page 102
Figure 28: Reasons why depression patients are noncompliant, 2004 - page 103
Figure 29: Noncompliance due to the 'fear' versus 'actual occurrence' of a side effect in depression in the US, 2004 - page 105
Figure 30: Noncompliance due to the 'fear' versus 'actual occurrence' of a side effect in depression in Japan, 2004 - page 106
Figure 31: Noncompliance due to the 'fear' versus 'actual occurrence' of a side effect in depression in the EU, 2004 - page 107
Figure 32: Actions taken for noncompliant depression patients, 2004 - page 110
Figure 33: How well drug formulations improve compliance in depression, 2004 - page 111
Figure 34: How well non drug approaches improve compliance in depression, 2004 - page 113
Figure 35: The effect of patient education sources on treatment compliance in depression, 2004 - page 119
Figure 36: Zoloft US product website promoting the "Knowing More" program to new patients - page 121
Figure 37: Excerpt from Strattera support brochure "Parents: What Should I Expect with Strattera?" - page 122
Figure 38: Prescription growth and DTC spend for selected US antidepressants, 2001-03 - page 123
Figure 39: Drug versus non drug first line therapy, 2004 - page 145
Figure 40: Monotherapy versus combination first line therapy, 2004 - page 146
Figure 41: First line monotherapy for schizophrenia, 2004 - page 147
Figure 42: First line monotherapy for bipolar disorder, 2004 - page 148
Figure 43: First line 2-drug combination therapy for bipolar disorder, 2004 - page 149
Figure 44: First line monotherapy for depression, 2004 - page 150

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Patient Compliance in Psychiatry - From Patient Acquisition to Patient Retention

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