2013 U.S. Drug Delivery Technologies
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Transcript of 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
Source: Frost & Sullivan analysis.
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
Source: Frost & Sullivan analysis.
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
Source: Frost & Sullivan analysis.
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
Source: Frost & Sullivan analysis.
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
Source: Frost & Sullivan analysis.
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
Source: Frost & Sullivan analysis.
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
Source: Frost & Sullivan analysis.
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
Base: Filtered by diseases treated. See appendices for sample sizes.
Q18. How would you rate the importance of each of the following factors on patient compliance with their drug
therapy?
11
Source: Frost & Sullivan analysis.
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
External infusion pump
Topical gel or cream
Transdermal patch
Subcutaneous injection (vial & syringe/PFS)
Implantable infusion pump
Nasal inhalation
Intramuscular injection (autoinjector)
Intravenous injection
Intravenous infusion
Rectal
Intramuscular injection (vial & syringe/PFS)
Intradermal injection
Patient Compliance with Drug Therapy by Method—Highest/High Compliance
Patient Compliance with Drug Therapy by Method When
Treating Type 2 Diabetes
Base: Filtered by diseases treated. See appendices for sample sizes.
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
Source: Frost & Sullivan analysis.
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
Source: Frost & Sullivan analysis.
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
Implantable infusion pump
External infusion pump
Transdermal patch
Topical
Implant
Oral (e.g. capsule)
Oral-liquid
Rectal
Intradermal injection
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
Source: Frost & Sullivan analysis.
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
Source: Frost & Sullivan analysis.
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.
Base: Filtered by diseases treated. See appendices for sample sizes.
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
Source: Frost & Sullivan analysis.
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.