2013 u.s. drug delivery technologies

2013 U.S. Drug Delivery Technologies

End-User Usage Patterns, Preferences, and Opportunities

Among Physicians

June 18, 2013

2

Contents

Section Slide Number

Research Background, Objectives, and Methodology 4

Executive Summary 9

The Impact of Physicians’ Attitudes on Behavior 15

Impact of Drug Delivery Method Features on Selection 23

Drug Delivery Method Preferences by Disease 30

The Drivers of Satisfaction on the Overall Experience with Drug Delivery

Methods by Disease 38

Most Prevalent Drug Brands by Disease 57

Threats to Branded Drugs Due to Switching Behavior Related to Drug

Delivery Methods 77

Drug Delivery Administration Process by Disease 97

Impact of Drug Delivery Method on Patient Compliance by Disease 116

Appendices 136

The Frost & Sullivan Story 395

3

Source: Frost & Sullivan analysis.

Physician Profile Differences by Adoption Segmentation:

Area of Specialization

More innovators and early adopters specialize in psychiatry, endocrinology, and gastroenterology.

14%

14%

13%

21%

11

%

7%

7%

13%

0%

17%

33%

17%

33%

0%

0%

0%

14%

8%

12%

37%

10%

6%

4%

8%

16%

15%

15%

15%

13%

5%

13%

8%

14%

16%

10

% 17%

8%

10

%

2%

22%

Ca

rdio

log

y

Ne

uro

log

y

Psych

iatr

y

En

do

cri

no

log

y

Ga

str

oe

nte

rolo

gy

De

rma

tolo

gy

Rheum

ato

logy

Prim

ary

Ca

re

Area of Specialization

Total sample Innovators Early adopters Late majority Laggards

Base: All respondents (n=228).

S2. What is your area of specialization?

4


Strategic Prioritization of Drug Delivery Methods

Easy for doctors to administer

Easy for patients to self administer

Rapid onset of action

Improves recovery speed

Has minimal adverse side effects

Provides good bioavailability Improves drug delivery

to the target area Improves dose accuracy

Improves patient comfort

Improves patient convenience Positive role in patient

compliance

Is a lower cost alternative

Easier cost reimbursement

Preferential formulary tiering of product with

the delivery form

Is requested by patients

Long shelf life

Frequency of administration

Improves patient satisfaction

Manufacturer provides good patient education

and support

Better overall outcomes

Strategic Prioritization of Drug Delivery Methods

Sta

ted

Im

po

rta

nce

Drivers of Importance

Secret drivers

Non-

drivers

Strategic drivers Basic drivers

Overall, physicians are driven to select drug delivery methods that are directly related to patient compliance

(ease of self administration, satisfaction, and comfort) and are effective at treating the patient.

5


Preferred Drug Delivery Methods by Disease

Preferred Methods Among Physicians

Diseases

Afib/

Arrhythmia

Arterial

thrombosis

Deep vein

thrombosis

Ischemic

heart

disease

Alzheimer’s

disease Migraines

Intravenous injection 3% 13% 3% 3% - -

Subcutaneous injection (autoinjector) - 3% 3% - - -

Subcutaneous injection (vial & syringe/PFS) - - 8% - - -

Intramuscular injection (autoinjector) - - 3% 3% - -

Intramuscular injection (vial & syringe/PFS) - - 3% - - -

Intravenous infusion 6% 26% 5% 14% 4% -

Implantable infusion pump - - 3% - 4% -

External infusion pump - 3% - - - -

Transdermal patch - 3% - 3% 35% -

Topical gel or cream - - - - - -

Implant - - - - - -

Oral (capsule, pill or tablet) 88% 53% 74% 75% 54% 83%

Oral (liquid solution/suspension) - - - - - 6%

Rectal (suppository, enema, foam) 3% - - - 4% -

Intradermal injection - - - - - -

Nasal inhalation - - - 3% - 11%

Overall, oral drug delivery methods are most preferred by physicians for nearly all diseases. Generally,

physicians prefer drug delivery methods that are aligned with industry expectations, and when other drug

delivery methods are used, it is only among a small proportion of physicians.

Base: Filtered by diseases treated. See appendices for sample sizes.

Q3. Which drug delivery method do you most prefer when treating disease independent of the efficacy of the

drug?

6


Overview of Top Attribute Driving Satisfaction of Each

Drug Delivery Method When Treating Multiple Sclerosis

Drug Delivery Method

* indicates most preferred method

Specific Satisfaction Attribute Driving

Satisfaction When Treating Disease

Comparison to Attribute Most

Associated With (General—NOT Disease Specific)

Intravenous injection Drug delivery to the target area Drug delivery to the target area

Subcutaneous injection (autoinjector) Frequency of administration Overall outcomes

Subcutaneous injection (vial & syringe/PFS) Easy for doctors to administer --

Intramuscular injection (autoinjector) Manufacturer’s education and support to

patients Overall outcomes

Intramuscular injection (vial & syringe/PFS) Overall outcomes --

Intravenous infusion Drug delivery to the target area Bioavailability

Implantable infusion pump Sample sizes too small for analysis Overall outcomes

External infusion pump Sample sizes too small for analysis Frequency of administration

Transdermal patch Easy for doctors to administer Frequency of administration

Topical gel or cream Sample sizes too small for analysis Easier cost reimbursement

Implant Sample sizes too small for analysis --

Oral (capsule, pill or tablet)* Has minimal adverse side effects Long shelf life

Oral (liquid solution/suspension) Preferential formulary tiering of product --

Rectal (suppository, enema, foam) Dose accuracy --

Intradermal injection Bioavailability Overall outcomes

Nasal inhalation Improves patient satisfaction Manufacturer provides

patient education/support

Strategic drivers Basic drivers Secret drivers Non-drivers

When treating multiple sclerosis the top factor driving satisfaction for intravenous injection is a strategic driver

for selection and also generally most associated with this method: drug delivery to the targeted area.

However, intravenous injection is not a preferred drug delivery method when treating multiple sclerosis.

7


When treating ADHD, there are multiple drug brands that are prevalently prescribed/administered—with

Adderall XR as the most prevalently prescribed (28 percent).

28%

25%

19%

16%

13%

0%

0%

Adderall XR

Vyvanse

Ritalin/Ritalin LA/generic equivalent

Concerta/generic equivalent

Strattera

Intuniv

Other drug type

Prevalent Drug Brand Prescribed/Administered

Prevalent Drug Brand Prescribed/Administered When

Treating ADHD

Base: Filtered by disease (n=32).

Q8a. Which one type of drug do you prescribe or administer most often for the treatment of disease?

8


Summary of Most Threatening Drug Delivery Methods to

Branded Drugs

Diseases Current Methods Used in Branded Drugs

Most Threatening Drug Delivery

Method to Branded Drugs

Threat

Level

Afib arrhythmia Oral Transdermal patch

Arterial thrombosis Oral and subcutaneous injection Transdermal patch

Deep vein thrombosis Oral and subcutaneous injection Transdermal patch

Ischemic heart disease

Oral, subcutaneous injection, IV injection/infusion, and

transdermal Topical gel or cream

Alzheimer’s disease Oral and transdermal Topical gel or cream

Migraines Oral Nasal inhalation

Multiple sclerosis Oral and subcutaneous and intramuscular injection Transdermal patch

ADHD Oral Topical gel or cream

Depression Oral Transdermal patch

Schizophrenia Oral and intramuscular injection Transdermal patch

Obesity Oral and subcutaneous injection Topical gel or cream

Type 1 diabetes Subcutaneous injection Oral (capsule, pill, or tablet)

Type 2 diabetes Oral and subcutaneous injection Topical gel or cream

Crohn’s disease Oral, subcutaneous injection, and IV infusion

Transdermal patch & Nasal

inhalation (tie)

Ulcerative colitis Oral, subcutaneous injection, and rectal Transdermal patch

Psoriasis Oral, subcutaneous injection, IV infusion, and topical Transdermal patch

Rheumatoid arthritis Oral, subcutaneous injection, and IV infusion Transdermal patch

Overall, most branded drugs currently rely upon oral drug delivery methods, but physicians are most

likely to switch from current branded drugs to offer their patients less invasive drug delivery methods

such as transdermal patches, topicals, and nasal inhalations—with strongest threats for those treating

migraines, multiple sclerosis, and type 1 diabetes.

Strong (50% or more likely to switch) Moderate (20% to 49% likely to switch) Weak (Less than 20% likely to switch)

9


54%

43%

40%

20%

9%

9%

9%

9%

9%

9%

6%

6%

6%

3%

Nasal inhalation

Transdermal patch

Topical gel or cream

Subcutaneous injection (autoinjector)

Intravenous injection

Intramuscular injection (autoinjector)

Intramuscular injection (vial & syringe/PFS)

Implant

Rectal (suppository, enema, foam)

Intradermal injection

Subcutaneous injection (vial & syringe/PFS)

Implantable infusion pump

External infusion pump

Intravenous infusion

Likelihood to Switch From Branded Drug Due to New Drug Delivery Method—Very/Somewhat Likely

Likelihood to Switch From Branded Drug Due to New Drug

Delivery Method When Treating Migraines

Base: Filtered by disease (n=35).

Q8b. How likely would you be to switch away from (DRUG BRAND) based solely on the mode of delivery when

treating disease?

Currently migraines is predominantly treated using oral drug delivery methods when using branded drugs.

The largest proportion of physicians treating migraines are likely to switch from currently prescribed branded

drugs if drug delivery became available in a nasal inhalation, topical, or transdermal patch.

10


Factors that make it easier for a patient (i.e., convenience, ease of use, comfort) and directly impact the

treatment of the disease (i.e., efficacy, side effects) are rated as most important on patient compliance

with drug therapy.

89%

88%

88%

87%

87%

86%

77%

77%

68%

67%

Convenience

Ease of use

Drug efficacy

Comfort

Adverse side effects

Frequency of dosing

Personal responsibility

Cost

Length of time on medication

Patient education

Importance of General Factors on Patient Compliance—Very/Somewhat Important

Impact of General Factors on Patient Compliance


Q18. How would you rate the importance of each of the following factors on patient compliance with their drug

therapy?

11


According to physicians, patient compliance with drug therapy is highest among those using less

invasive drug delivery methods.

91%

81%

70%

70%

63%

55%

50%

44%

42%

40%

38%

36%

30%

30%

29%

8%

Oral (capsule, pill or tablet)

Oral (liquid solution/suspension)

Subcutaneous injection (autoinjector)

Implant


Topical gel or cream

Transdermal patch

Subcutaneous injection (vial & syringe/PFS)


Nasal inhalation

Intramuscular injection (autoinjector)

Intravenous injection

Intravenous infusion

Rectal

Intramuscular injection (vial & syringe/PFS)


Patient Compliance with Drug Therapy by Method—Highest/High Compliance

Patient Compliance with Drug Therapy by Method When

Treating Type 2 Diabetes


Q17. How would you rate patient compliance to drug therapy delivered by each of the following drug delivery

methods?

2013 U.S. Drug Delivery Technologies

End-User Usage Patterns, Preferences, and Opportunities

Among Patients

June 18, 2013

13

Contents

Section Slide Number

Research Background, Objectives, and Methodology 4

Executive Summary 9

The Impact of Patients’ Attitudes on Behavior 13

Impact of Awareness on Usage of Drug Delivery Methods by Disease 23

Impact of Drug Delivery Method Features on Selection 41

Potential Opportunities for Other Drug Delivery Methods When Treating

Diseases 48

The Drivers of Satisfaction on the Overall Experience with Drug Delivery

Methods by Disease 66

Most Prevalent Drug Brands by Disease 113

Patient Compliance Related to Adherence of Medication Schedule 131

Drug Delivery Administration Process by Disease 152

Factors Influencing Switching Behavior 155

Appendices 160

The Frost & Sullivan Story 193

14


55%

24%

21%

Derived Segmentation* Based Upon Attitudes Toward

Disease Treatment

Suffering

patients: Medication has

adverse side effects;

Have missed out on

social activities as a

result of drug

administration issues

in treating my

condition;

Regularly dread having

to take my medication

because of the pain

and discomfort;

Drug administration for

my condition has had a

negative impact on my

family or friends

Forgetful patients: Do not strictly adhere to my

prescriptions;

Need to be reminded to take my

medication

Model patients: Strictly adhere to my

prescriptions;

Have received sufficient

instructions on the proper

use of my medication;

Medication is effective

and has a positive effect

on me;

prescribed schedule is

right for me;

Satisfied with my current

medication

*Grouping of attitudes within segments are accomplished using factor analysis. Extraction Method: Principal

Component Analysis. Rotation Method: Varimax with Kaiser Normalization. Variance explained: 57%

(36% 1st component; 16% 2nd component; 5% 3rd component); KMO: 0.922; p-value <= 0.00)

More than half of patients are suffering—

dreading their treatment and their

disease is having a negative impact on

their lives.

15


Willingness to Use Methods, Assuming FDA Approved and

Effective as Current Method: Multiple Sclerosis

21%

14%

15%

13%

27%

18%

25%

23%

6%

6%

21%

5%

6%

31%

14%

10%

19%

11%

22%

22%

24%

27%

25%

23%

25%

24%

8%

8%

38%

28%

29%

28%

33%

31%

38%

44%

32%

32%

37%

15%

17%

35%

52%

37%

19%

28%

27%

26%

13%

16%

8%

28%

32%

10%

13%

29%

10%

20%

22%

19%

7%

11%

9%

6%

30%

26%

8%

64%

46%

6%

24%

IV injection

SC injection-pen

SC injection-syringe

IM injection-pen

IM injection-syringe

IV infusion



Transdermal patch

Topical

Implant

Oral (e.g. capsule)

Oral-liquid

Rectal


Nasal inhalation

Willingness to Use Methods, Assuming FDA Approved and Effective as Current Method

Will definitely not use it

Unwilling but will comply if prescribed by doctor

Indifferent or don't know

Willing to use it

Very willing to use it

Acceptance is highest with oral-capsule, etc. methods, while rectal methods have the lowest acceptance

levels.

Note: Data labels in chart not shown for percents five percent or less.

Base: Filtered by disease being treated (n=<54).

Q4. Please indicate how willing you are to use each of the following drug delivery methods in the future for your disease if it were to become

available to you?

16


For intravenous infusion, device design is a top factor driving satisfaction, closely followed by reputation

among doctor, likelihood of reimbursement and cost or insurance co-pay.

0

8

20

25

36

40

42

70

72

72

77

93

95

98

100

Frequency of dosing required

Easy for others to administer for me

Able to be administered in my home

Easy disposal

Minimal side effects

Convenient to use

Impact to my daily activities

Easy to self administer at home

No or minimal discomfort

Easy to take on the go (e.g. portable)

Onset of drug action

Cost or insurance co-pay

Likelihood of reimbursement

Reputation among doctor

Device design

Drivers of Satisfaction: Intravenous Infusion when Treating Crohn’s Disease

Drivers of Satisfaction: Intravenous Infusion When

Treating Crohn’s Disease

Base: Filtered by disease and method used (n=11).

Q3. Using the 5-point scale below, what is your level of satisfaction with the (DRUG DELIVERY METHOD) you

are currently using or your doctor or nurse is using to administer your medication for your (DISEASE)?

17


Overall Impact of Costs on Switching Behavior

19%

32% 48%

-10%

10%

30%

50%

70%

Costs 50 percent more Costs 25 percent more Costs 10 percent more

Impact of Costs on Likelihood to Switch from Current Method to an Improved Method—Percent Definitely/Probably Would Use

ADHD Afib arrhythmia Arterial thrombosis Crohn’s disease Deep vein thrombosis Depression Ischemic heart Migraines Multiple sclerosis Obesity Psoriasis Rheumatoid arthritis Type 1 diabetes Type 2 diabetes Ulcerative colitis Total average

On average, approximately one out of five patients with various diseases definitely/probably would use a

new, improved method even at a cost increase of 50 percent above their current method—with increasing

proportion of switching likelihood with decreased cost implications. Assuming only a ten percent cost increase

is enticing for nearly half. Switching likelihood is highest for those with Crohn’s disease, at both a 25 and ten

percent increase assumption.


Q13a/b/c. If a new type of drug delivery method makes all the improvements that you are looking for and cost

50/25/10 percent more than your current treatment, how likely would you be to use it?

18


Aligned with results throughout this research, patients are most influenced by a device driven drug

delivery product that is easy to self administer. However, other strong secondary factors follow.

80%

76%

75%

75%

68%

59%

58%

58%

54%

50%

49%

25%

Easy to self administer

Device is comfortable to use

Recommended by physician

Out of pocket cost

Specific adverse side effects to using that device

Does not require power source/batteries

Complexity of device

Published clinical data

Size of device

Need to refrigerate the drug portion

Has reusable component/environmentally friendly

Appealing appearance of device

Influential Factors for Selecting a Device Driven Drug Delivery Product—Percent Highly/Somewhat Influential

Influential Factors for Selecting a Device Driven Drug

Delivery Product

Base: All respondents (n=664).

Q15. Rate the level of influence the following features would have on your decision to use a drug

delivery device.

2013 u.s. drug delivery technologies

Health & Medicine

drug delivery technologies

delivery form

disease preferred methods

patient comfort

prevalent drug brands

drivers of satisfaction

good patient education

frost sullivan analysis