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ABOUT DATAMONITOR HEALTHCARE
- About the CNS pharmaceutical analysis team
CHAPTER 1 EXECUTIVE SUMMARY
- Scope of the analysis
- Summary
- Key metrics
- Study methodology and sample details
CHAPTER 2 OVERVIEW OF PATIENT COMPLIANCE IN PSYCHIATRY
- Definition of patient compliance
- Frequency of noncompliance across psychiatry indications
- Epidemiology of schizophrenia
- Overview
- Prevalence
- Diagnosis and treatment rates
- Compliance rates
- Epidemiology of bipolar disorder
- Overview
- Prevalence
- Diagnosis and treatment rates
- Compliance rates
- Epidemiology of depression
- Overview
- Prevalence
- Diagnosis and treatment rates
- Compliance rates
- Cost of noncompliance to pharmaceutical companies
- Strategies shown to improve compliance
- Treatment-related
- Minimize drug side effects
- Drug regimen
- Reminder or compliance packaging by manufacturer
- Number of doses per day
- Unit dose convenience packs
- Pill boxes
- Drug delivery systems
- Clinician-related
- Patient counseling
- Patient education and psychotherapy
- Communication training
- Patient education and compliance monitoring
- Home visits
- Patient related
- Patient-skill building "Medication chart"
- Reminders by telephone
- Clinic and telephone visits with written correspondence
- Electronic devices
- Family support
- Support group sessions
- General considerations for patient compliance programs
- Improving relationships with end-users makes good commercial sense
- Interventions must be highly relevant to the individual
- Information needs to be given throughout the treatment course
- Specific European opportunities
- Acceptance of depot formulations beyond schizophrenia
- Patient education through Health professional led local meetings
- Summary
CHAPTER 3 PATIENT COMPLIANCE IN SCHIZOPHRENIA
- Market overview
- First line treatment of schizophrenia
- Reasons for noncompliance in chronic schizophrenia
- General reasons
- Lack of insight and drug side effects are key to noncompliance
- Perceived treatment success suggest a need for education prior to
and during drug treatment
- Side effect-specific reasons
- Weight gain is a big problem
- BMS needs to emphasize in Abilifys marketing messages that it
causes minimal weight gain compared to rivals
- Care managers do not normally warn patients about side effects
- 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
- Side effect management programs can improve patient retention
- Case Study: Lillys Solutions for Wellness program
- Actions taken for noncompliant schizophrenia patients
- Drug switching is a primary source of lost revenue
- Approaches to improving compliance in schizophrenia
- Drug approaches
- There is a need for more atypical depots
- Pain at site of injection is a problem for patients taking depots
- Non drug approaches
- A good therapeutic alliance is key
- Directly observed therapy is good in theory but problematic in
practice
- Involving the family is challenging but effective
- Influence of educational sources
- The therapist is the best source of information on treatment
compliance
- Websites and DTC advertising are good sources of general
information but are not so good for providing specific drug
compliance education
- Patient education should be given at different stages of treatment
and tailored to the individual
- Case study: Lillys Meaningful Day educational program
- Datamonitor conclusions and recommendations
CHAPTER 4 PATIENT COMPLIANCE IN BIPOLAR DISORDER
- Market overview
- First line treatment of bipolar disorder
- Reasons for noncompliance in bipolar disorder
- General reasons
- Side effect-specific reasons
- Actions taken for noncompliant bipolar disorder patients
- Approaches to improving compliance in bipolar disorder
- Drug approaches
- Lessening the burden of oral pills is a good strategy
- Combination pills offer few advantages
- Non drug approaches
- Leading players provide free compliance tools such as mood diaries
- Influence of educational sources
- Websites are not viewed as useful sources of information
- The trend is to support health information sites
- Public information is beneficial but key messages must be
unrelated to product-specific marketing
- Datamonitor conclusions and recommendations
CHAPTER 5 PATIENT COMPLIANCE IN DEPRESSION
- Market overview
- First line treatment of depression
- Reasons for noncompliance in depression
- General reasons
- A multitude of reasons are responsible for noncompliance in
depression
- Patients will be noncompliant whether the drug does or does not
work
- Side effect-specific reasons
- Sexual dysfunction is a leading cause of noncompliance in the US
and EU
- Case study: GSKs Wellbutrin-XL successfully promoted as the only
once-daily antidepressant without sexual side effects
- Media coverage of the SSRI suicide risk story increased
noncompliance
- Actions taken for noncompliant depression patients
- Approaches to improving compliance in depression
- Drug approaches
- Reformulation is not the way to go in the US depression market
- Non drug approaches
- A strong therapeutic-alliance and patient education are key means
of improving compliance in depression
- Collaborations with patient advocacy groups are recommended
- Esteve launches innovative PatientFeedback tool to improve
communication between depression patients and their therapists
- Influence of educational sources
- DTC advertising is not practical as a compliance improving tool
- Case study: Pfizers Rhythms patient education campaign was an
effective patient compliance strategy
- Compliance aids are less accessible on depression information
websites
- Effective disorder information leaflets need to be clear,
informative and stimulating
- CME programs targeted to healthcare providers offer greater
coverage of education
- Datamonitor conclusions and recommendations
APPENDIX A
APPENDIX B
- Sample details
- First line treatment
- General details
- Physician research methodology
- Study questionnaire
APPENDIX C
- About Datamonitor
- About Datamonitor Healthcare
- About the CNS analysis team
- Key therapy team members
- Lynda Lynch, Director CNS
- Disclaimer
- List of Tables
- Table 1: Key schizophrenia epidemiology, 2004
- Table 2: Key bipolar disorder epidemiology, 2004
- Table 3: Key depression epidemiology, 2004
- Table 4: Sample details for the Stakeholder Insight: Patient
Compliance in Psychiatry Survey, 2004
- Table 5: Key schizophrenia epidemiology, 2004
- Table 6: Key bipolar disorder epidemiology, 2004
- Table 7: Key depression epidemiology, 2004
- Table 8: Percentage patient compliance versus number of doses per day
- Table 9: Side effect profile comparison of key antipsychotics
- Table 10: Sample details of the Patient Compliance in Psychiatry
Survey, 2004
- List of Figures
- Figure 1: Noncompliance rates across psychiatric disorders, 2004
- Figure 2: Lamictals fold-out compliance packaging
- Figure 3: First line monotherapy for schizophrenia, 2004
- Figure 4: Reasons why schizophrenia patients are noncompliant, 2004
- 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
- Figure 6: Noncompliance due to the fear versus actual occurrence
of a side effect in schizophrenia in the US, 2004
- Figure 7: Noncompliance due to the fear versus actual occurrence
of a side effect in schizophrenia in Japan, 2004
- Figure 8: Noncompliance due to the fear versus actual occurrence
of a side effect in schizophrenia in the EU, 2004
- Figure 9: Actions taken for noncompliant schizophrenia patients, 2004
- Figure 10: How well drug formulations improve compliance in
schizophrenia, 2004
- Figure 11: Quarterly sales of Risperdal Consta in the EU and US,
2002-2004
- Figure 12: How well non drug approaches improve compliance in
schizophrenia, 2004
- Figure 13: The effect of patient education sources on treatment
compliance in schizophrenia, 2004
- Figure 14: First line monotherapy for bipolar disorder, 2004
- Figure 15: First line 2-drug combination therapy for bipolar disorder,
2004
- Figure 16: Reasons why bipolar disorder patients are noncompliant,
2004
- Figure 17: Noncompliance due to the fear versus actual occurrence
of a side effect in bipolar disorder in the US, 2004
- Figure 18: Noncompliance due to the fear versus actual occurrence
of a side effect in bipolar disorder in Japan, 2004
- Figure 19: Noncompliance due to the fear versus actual occurrence
of a side effect in bipolar disorder in the EU, 2004
- Figure 20: Actions taken for noncompliant bipolar disorder patients,
2004
- Figure 21: How well drug formulations improve compliance in bipolar
disorder, 2004
- Figure 22: Quarterly sales of Symbyax in the US, 2004
- Figure 23: How well non drug approaches improve compliance in bipolar
disorder, 2004
- Figure 24: Eli Lillys downloadable Mood Diary program for the PC
- Figure 25: The effect of patient education sources on treatment
compliance in bipolar disorder, 2004
- Figure 26: A bipolar disorder information website sponsored by GSK
- Figure 27: First line monotherapy for depression, 2004
- Figure 28: Reasons why depression patients are noncompliant, 2004
- Figure 29: Noncompliance due to the fear versus actual occurrence
of a side effect in depression in the US, 2004
- Figure 30: Noncompliance due to the fear versus actual occurrence
of a side effect in depression in Japan, 2004
- Figure 31: Noncompliance due to the fear versus actual occurrence
of a side effect in depression in the EU, 2004
- Figure 32: Actions taken for noncompliant depression patients, 2004
- Figure 33: How well drug formulations improve compliance in
depression, 2004
- Figure 34: How well non drug approaches improve compliance in
depression, 2004
- Figure 35: The effect of patient education sources on treatment
compliance in depression, 2004
- Figure 36: Zoloft US product website promoting the "Knowing
More" program to new patients
- Figure 37: Excerpt from Strattera support brochure "Parents: What
Should I Expect with Strattera?"
- Figure 38: Prescription growth and DTC spend for selected US
antidepressants, 2001-03
- Figure 39: Drug versus non drug first line therapy, 2004
- Figure 40: Monotherapy versus combination first line therapy, 2004
- Figure 41: First line monotherapy for schizophrenia, 2004
- Figure 42: First line monotherapy for bipolar disorder, 2004
- Figure 43: First line 2-drug combination therapy for bipolar disorder,
2004
- Figure 44: First line monotherapy for depression, 2004
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