# Presentation: 647720

## Cliff Thumma
Director, Team Leader, Global Market Analytics
Pfizer Inc.

***DTC Advertising and ******Doctor-Patient Interactions***

- Presented at the FDA DTC Public Hearing
- September 23, 2003

- Cliff Thumma
- Director, Team Leader, Global Market Analytics
- Pfizer Inc.

## Successful Treatment Requires....

***Successful Treatment Requires....***

- Motivation

- Engagement

- Commitment

*...To become more informed*
*...To seek diagnosis and treatment** *
*Interaction with a healthcare professional** *
*Persistence on therapy*

## Motivation

## Advertising motivates information seeking, engagement and new diagnoses

- Patients consistently report that advertising provides them with important information1
- Advertising is motivating people to seek additional health information2
- Health information must be presented in a way that patients can understand3
- Patients are being motivated to speak to  their physicians by information they receive through advertising4
- Advertising-driven conversations are resulting in new diagnoses of important conditions5

- 1Sources:  Prevention annual surveys, FDA Patient surveys, Verispan (Scott/Levin) tracking, Market Measures/Cozint DTC Monitor,
- 2Sources:  Prevention annual surveys, FDA Patient surveys
- 3 Sources:  GAO “meta-analysis” of available research, Prevention annual surveys, FDA Patient surveys, Harris/Harvard survey,         Market Measures/Cozint DTC Monitor
- 4 Source:   National Adult Literacy Survey 1993
- 5Sources:  Prevention annual surveys, FDA Patient surveys, Harris/Harvard survey

## Engagement

## Advertising and engagement

**Consumer data suggests a greater patient interest in “finding out” than “getting”**
**National Consumer League Study (2003):  51% “wanted to find out if product was right for them” vs. 9% “wanted to get drug”**
**FDA Patient Study (2002):  More often asked “about drug” than “for drug”**** **
**Patients consistently report positive interactions with their physicians**

***...******But what is the physician perspective? ***

## Market Measures DTC Dialogue Study

- Understand the impact of advertising on _actual doctor-patient interactions_ in the **High Cholesterol** and **Mood/Anxiety Disorder** categories.
- Address interactions where patients initiate conversations about prescription drugs
- Focus on the interaction first, and advertising second
- Ask doctors to report on specific experiences and how DTC impacted then, rather than on general attitudes
**Similar in objective to a portion of FDA’s physician survey *****(“last interaction where a patient mentioned an ad”)***

## Methodology: MMC DTC Dialogue

**Physician randomly recruited from panel to participate in research**** **
**Physician experiences a **_***patient-initiated discussion***_** about an advertised brand in the relevant category**
**Physician calls a 1-800 number to complete an interview about that specific interaction.  Only one call per physician**

***Methodology: MMC DTC Dialogue***

**Fifteen-minute interviews conducted among a total of 417 physicians recruited from the Market Measures/Cozint (MMC) physician network **
**212 interactions about High Cholesterol**
**205 physician interactions about Mood/Anxiety Disorder**

## MMC DTC Dialogue Methodology:Sample Sizes

***MMC DTC Dialogue Methodology:******Sample Sizes***

***417 Doctor-Patient***
***Interactions***

**106 primary care physicians**
**106 cardiologists**

**104 primary care physicians**
**101 psychiatrists**

***Total Patients Initiating a Discussion About an Rx Cholesterol Drug ******(212 Physician Responses)***

***Total Patients Initiating a Discussion ******About an Rx Mood/Anxiety Disorder Drug ******(205 Physician Responses)***

**Mood/Anxiety Disorder**

**High Cholesterol**

**37%**

- NoN=78

- NoN=97

- YesN=134

- YesN=115

**63%**

**54%**

**46%**

**51%**

- NoN=105

- NoN=55

- YesN=100

- YesN=150

**49%**

**73%**

**27%**

**Did Patient Mention an Ad?**

**Did Patient Request a Drug?**

**Did Patient Mention an Ad?**

**Did Patient Request a Drug?**

## Many--but not all--patient initiated discussions about drugs include a reference to advertising

***Patients Initiating a Discussion ***
***About an Rx Cholesterol Drug ******(N=212)***

***Did Patient Mention an Ad?***

**63%**

- No

- Yes

**37%**

- Ref:  Page C1

***High Cholesterol***

***Patients Initiating a Discussion ***
***About an Rx Mood/Anxiety Drug ******(N=205)***

***Did Patient Mention an Ad?***

**49%**

- No

- Yes

**51%**

- Ref:  Page MA1

***Mood/Anxiety Disorder***

## Physicians reported largely positive impact of advertising on their interaction with patients

- Ref:  Page C6, C8

- No: 44 %

- No: 85%

**Yes**** **Saw PositiveImpact

**Yes **Saw Negative Impact

**56% **

**15% **

- Ref:  Page MA6, MA8

- No: 34 %

- No: 91%

**Yes**** **Saw Positive Impact

**Yes **Saw Negative Impact

**66% **

**9% **

***Did the fact that the patient saw ******an advertisement ***
- ...have a ***positive impact*** on the interaction?
- ...have a ***negative impact*** on the interaction?*** ***

***High Cholesterol***

***Mood/Anxiety Disorder***

## Physicians reported more thorough discussions with patients who mentioned ads

**Did Patient Ask About...**

- *If drug is better than current drug (among those  already on medication for cholesterol)

**Did Patient Ask About...**

- *If drug is better than current drug (among those  already on medication for mood/anxiety disorder)

***Physicians reported more thorough discussions with patients who mentioned ads***

***High Cholesterol***

***Mood/Anxiety Disorder***

- Dr’s Opinion on Drug

- Efficacy

- Cost of Drug

- Side Effects

- If Drug is Better*

- Alternatives to Drugs

- If Plan Covered Drug

***91***

**67**

***78***

**58**

**42**

***47***

**29**

**46**

**81**

***79***

**60**

***75***

**53**

**42**

**40**

**32**

- Alternative Meds

- Dr’s Opinion on Drug

- If Drug is Better*

- Cost of Drug

- Side Effects

- Efficacy

- Alternative Meds

- If Plan Covered Drug

- Alternatives to Drugs

***92***

**79**

***78***

**55**

**36**

***32***

**18**

***25***

**86**

**78**

**71**

***73***

***35***

**20**

***23***

**20**

- Significant difference @ 95% confidence level

- Significant difference @ 95% confidence level

- Ref. Page MA14

- Ref. Page C14

## Physicians reported that patients asked about products that were appropriate for them and their condition

**85%****1**** of physicians reported that patients inquired about  a medicine that was appropriate for them**
**72% ****1**** of physicians found the discussion to be a valuable part of the office visit.**

**83% ****1**** ****of physicians reported that**** ****patients inquired about a medicine that was appropriate for them**
**76% ****1**** ****of physicians found the discussion to be a valuable part of the office visit.**

***High Cholesterol***

***Mood/Anxiety Disorders***

- 1Rated 5,6,7 on a 7-point scale	(Ref Page:  C13,C&; MA13,MA7)

## Most physicians reported little pressure to prescribe

***Most physicians reported little pressure to prescribe***

*1 = “No Pressure”*
*7 = “A Lot of Pressure”*

- Ref:  Pages C19, MA17

***High Cholesterol***

***Mood/Anxiety Disorder***

## Commitment

## Physicians reported a belief that patients who participate in treatment decisions would be more compliant

- Strong agreement that receiving a requested medicine increased the likelihood that a patient would:
- Fill the prescription
- Take the medication as prescribed
- Tolerate nuisance side effects
- 2/3 of physicians also believe that patients would be more receptive to diet and lifestyle change

- Ref:  Pages C21, MA21

## And there is in-market evidence that involvement and reinforcement increases compliance

- Longitudinal patient studies have shown that patients who request and receive a drug remain on therapy longer1
- Other studies have documented higher refill rates among patients who are aware of advertising for “their” product2

**1****Pfizer/RxRemedy Compliance Analysis (available at www.pfizer.com)**
**2****Pfizer analysis of Ipsos-PharmTrends longitudinal panel data.  See also Ipsos-PharmTrends *****“Industry Insights”,***** ****Summer 2002 for a similar publicly available analysis.  **

## Successful Treatment Requires....

***Successful Treatment Requires....***

- Motivation

- Engagement

- Commitment

*...To become more informed*
*...To seek diagnosis and treatment** *
*Interaction with a healthcare professional** *
*Persistence on therapy*

## Attachments(Contextual Data Referenced in Body of Presentation)

## Patients report that advertising provides them with important information

***Advertising of prescription drugs****** to the general public******1******...***

**1 ****Verispan, DTC Audit, 2nd Quarter 2003**

***Verispan***

***Market Measures DTC Monitor****** ***

***Ads provide a valuable service in****** educating the public****** (among condition sufferers)******2******...***

**2****Market Measures/Cozint DTC Monitor 2001**

***Ads provides adequate information about the risks of taking medication***
***(among condition sufferers)******2******...***

## Advertising is motivating people to seek additional health information

**Benefits          81%**
**Risks               78**
**Indications     75****	****	**

***About What?******2***
**Rx they’ve never****	****	****39%****taken         **
**Rx for someone else****	****27**
**Rx they’ve just****	****	****17****started on**
**Rx they’ve been****	****	****11****on for a while     ****	****	**

***Advertising is motivating people to seek additional health information***

- 42% of consumers who see a DTC ad search for more information about a condition or treatment due to the ad1.
- 20% of consumers who see of a DTC ad (38 million people) consult a web-site, print ad or toll free number as a result of seeing the DTC ad2.

***Ad Prompted Information Search ***

- 1 Direct-to-Consumer Advertising of Prescription Drugs, 1999-2002: Preliminary Patient Survey Results,  June 18 2002
- 2 *Prevention*, *“*5th Annual Survey of Consumer Reaction to Direct-to-Consumer Advertising of Prescription Medications*”,* 2002

## Patients are being motivated to speak to  their physicians by information they receive through advertising

**13% of consumers have talked to****their physicians about a health condition for the first time because of an ad (25 million people) ****1**

- 1 *Prevention*, *“*5th Annual Survey of Consumer Reaction to Direct-to-Consumer Advertising of Prescription Medications*”,* 2002
- 2 General Accounting Office, “Prescription Drugs:  FDA Oversight of Direct-to-Consumer Advertising Has Limitations”, 2002
- 3 Harris/Harvard Study 2003

***Patients are being motivated to speak to  their physicians by information they receive through advertising***

***Prevention Magazine Study ***

***Harris/Harvard Study***

**35% of consumers have talked to****their physicians about an advertised medicine because of an ad (66 million people)****3**

***GAO Meta-Analysis***

**Review of 10 DTC related studies showed an average of 33% of consumers have talked to their physicians about an advertised medicine because of an ad ****2**

## Advertising-driven conversations are resulting in new diagnoses of important conditions

- 43% of Diagnoses were “High Priority” Conditions According to AHRQ/IQM Criteria:

- No Diagnosis

**46%**

**25%**

**20%**

- New Diagnosis

- Conversation Was About Existing Condition

- Missing/Unknown = 9%

**Diagnoses***

**9%**

- Source: Harvard / Harris Interactive Study, 2002

- Diabetes
- High Cholesterol
- Hypertension
- Depression
- Asthma
- Arthritis
- Anxiety

## Consumer data suggests a greater patient interest in “finding out” than “getting”

**1****National Consumers League, Consumers Taking Control**** with DTC Rx Ads, January 9, 2003**

***Which of the following BEST describes****** your expectations  before talking to your doctor?***

***2003 National Consumers****** League Survey***

***2002 FDA Patient****** Survey***

- Direct-to-Consumer Advertising of Prescription Drugs, 1999-2002: Preliminary Patient Survey Results,  June 18 2002

## Patients consistently report positive interactions with their physicians

***Which of These Possible Reactions Did Your Doctor Have When You Asked About the Drug? ***

**71%**

**79%**

**81%**

**4%**

**83%**

**86%**

**93%**

**3%**

**Angry or Upset**

**Reacted Like Ordinary Part of Visit**

**Discussed Drug**

**Welcomed Question**

- 1999  N = 220

- 2002   N = 223

***Relationship With Doctor***

**20%**

**76%**

**2%**

**1%**

**77%**

**21%**

**Better**

**Same**

**Worse**

**Asked about Rx**
**Did not ask**

- As a result of this visit, did your relationship with your doctor get better, get worse, or stay about the same?

- 2002  N=944

***2002 FDA Patient Survey***

- Direct-to-Consumer Advertising of Prescription Drugs, 1999-2002: Preliminary Patient Survey Results,  June 18 2002

## Patients who request and receive a drug remain on therapy longer

- Utilized the RxRemedy Information Service proprietary 25,000 patient longitudinal database.
- Data collected from 1997 - 2000.
- Analysis conducted at the therapeutic category level across five major advertised conditions.
- Allergy  (N= 2435 patients)
- Arthritis (N= 2769 patients)
- Diabetes (N= 1848 patients)
- Depression (N= 1613 patients)
- Elevated Cholesterol (N= 4059 patients)
- Patients categorized into three classes, and persistence tracked.
- Patient did not ask for Rx; doctor initiated prescription
- Patient asked without prompting from ad
- Patient asked with prompting from ad

- Pfizer/RxRemedy Analysis (available at www.pfizer.com)

## Higher refill rates among patients who are aware of advertising for their product

***Higher refill rates among patients who are aware of advertising for their product***

- 40% say the ad makes them feel better about the benefits
- 34% say the ad makes them feel better about safety
- 17% say the ad makes them more likely to take their medicine 1

**Patients who have seen an ad for****an Rx product they are taking**

***Attitudes***

***Behavior***

**Patients who have seen an ad for****an Rx product they are taking**

**Prevention, *****Annual DTC Study*****, 2001**

**Pfizer analysis of Ipsos-PharmTrends longitudinal panel data.  See also Ipsos-PharmTrends *****“Industry Insights”,***** Summer 2002 for a similar publicly available analysis.  (Category data are weighted averages of****brands within therapeutic area) **

_**# of Refills/Year**_