EphMRA Asia 2011 Post Conference News

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Asia in the Spotlight
November 2011
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workshop reports...2-19
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agency fair...40-41 conference sponsors...42 BRIC internet access study...43
workshop reports
Three workshops were held during the conference - on Forecasting, Sales
Force Effectiveness and Methodologies.
Workshop 1 Forecasting
Session Chair: Gareth Phillips, Synovate Healthcare
Gareth Phillips
Paper 1: Best Forecasting Practices for Asia: Eight Simple Ways to Improve Your Forecasts
Speakers: Rudiger Papsch, Managing Director, Asia, and Dulyalarp Nanthawatsiri, Research Director, GfK HealthCare
Introduction
Forecasting is a complex and rather technical matter. To make things even worse, it
can cause substantial financial damage to companies if they get their forecasts wrong.
Unfortunately, there are numerous examples of pharmaceutical companies that over- or
underestimated the market potential of their drugs, which resulted in misallocation of
resources or lost opportunities for them. This poses not only a significant challenge to a
company, but also to the career of the person preparing the forecasts, as it is fairly easy
to evaluate the accuracy of a forecast post hoc.
Rudiger Papsch
That is probably why one finds only two groups of people: those who are experts in
forecasting and those who prefer to stay away from it. Rarely one finds people in the
middle, that is, who see the need and value of good forecasting, but who at the same
time have a pragmatic approach to it and do not wish (or simply do not have the time) to
become experts in it.
This view is confirmed by a recent survey that GfK HealthCare conducted with 31 clients
from the pharmaceutical industry. Sixty-one percent indicated that they are not satisfied
with the way forecasting is conducted in their organisation, and 68% stated that their
organisation does not have a systematic and functional forecasting process in place.
Many different challenges were reported by the participants, and the most often mentioned
challenges were these:
Dulyalarp Nanthawatsiri
Forecasting requirements and challenges:
There are many different challenges
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A systematic approach to the challenges of forecasting
It is actually not difficult to group these challenges systematically along two dimensions:
nature of challenge (Technical versus Business) and source of challenge (Forecaster
versus Stakeholder). Based on these two dimensions it is possible to derive the following
matrix, which allows classifying each challenge into one of its quadrants:
•
Forecasting Techniques
•
Positioning (of the forecasting process in the business)
•
Communication
•
Quality & Monitoring
Forecasting requirements and challenges:
A systematic approach to the challenges
Thinking about these challenges, there is no reason why forecasting has to be such
a problem and sometimes causes so much discomfort to the forecaster. No doubt,
forecasting can be resource-intensive and challenging and usually involves many
technicalities which may not be easy to understand. From our point of view what causes
this situation is not something inherent to forecasting per se, but rather how we teach
and use forecasting. We often seem to stand in our own way and not utilise all those
possibilities that can greatly help us make forecasting a much smoother process (and at
the same time yield more accurate forecasts).
Good advice and best practice have been given before, but they are usually limited to
the technical aspect of forecasting (quadrant Forecasting Techniques). Even though
this aspect is very important, it is not the only aspect that can pose challenges to the
forecaster. Looking at the four quadrants we know there are three other aspects that need
to be addressed. Forecasts are not just made for spreadsheets but for use by people
in marketing, management and many other functions of the company to make better
business decisions. Good forecasting needs to address these aspects too.
Just by following a limited set of eight rules and best practices it is possible to address
the challenges on all four quadrants and to improve the forecasting process and
communication with stakeholders.
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Eight Proven Rules
That Will Improve Your Life as Forecaster
Eight good practices for the forecasting process and for
communication with stakeholders
The following rules are suggested to improve the forecasting process and the
communication and involvement of the various stakeholders across the organisation:
Quadrant 1: Forecasting Techniques
1) Keep it simple.
Various studies on forecasting methods have confirmed that simple methods
forecast at least as accurate as complex methods (e.g., M3-Competition).
Furthermore, simplicity keeps the forecasting process understandable, which
facilitates the involvement of other stakeholders.
2) Have a proper forecasting process in place, including documentation and presentation.
This will not only increase the accuracy and efficiency of the forecasting process, but also ensure that the process is transparent.
Quadrant 2: Positioning
3) Keep the business objectives in mind - always.
Forecasting is a business activity with a clear business objective. Therefore it has to be matched to the business decision and the target audience.
4) Accept that forecasts may not always be popular.
The objective of forecasting is not to be popular, but to give the most accurate
estimation of the future. Of course this is easier said than done, but if you
follow the other seven rules, you have already started to manage this
problem effectively.
Quadrant 3: Communication
5) Make your forecasts transparent and involve the stakeholders openly and often.
Because forecasts influence major business decisions many stakeholders
are involved. Naturally they have different point of views and interests. Involve
them early to get their buy in and expertise. The key is to focus on inputs
(assumptions), not on the output (results).
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6) Manage expectations of your internal clients and management.
Future prediction with precise numbers always involves a certain degree of
error. Clearly communicate this fact to stakeholders. Even a forecast that is not
perfectly accurate will still allow for making better business decisions than those
based on gut feeling.
Quadrant 4: Quality & Monitoring
7) Follow your organisation’s best practices and use Excel if you have a choice.
If your organisation has best forecasting practices in place, it is usually
advisable to follow them and to work closely with the internal forecasting
experts. The software package Excel has been proven a useful forecasting
tool as its spreadsheet approach allows for preparing transparent and flexible
forecasting models.
8) Evaluate your forecasts and build a track record.
Comparison of forecasts with actual outcomes is the most effective way to
improve them. Various measures for forecasting errors are available; the Mean
Absolute Percentage Error (MAPE) is usually the recommended choice (simple
and meaningful). Keeping a track record will also help you to build
your reputation.
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Asia Pacific Eastern Europe Latin America
Middle East & Africa
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Paper 2: Oncology Forecasting in China
Speakers: Simon Li, General Manager China, Kantar Health and Todd Johnson, Senior Director Forecasting, Kantar Health
Oncology: one of the most complex and challenging therapy areas in our industry. Add to
that the words “forecasting” and “China” and many of us will recognise the challenge!
However as our second paper in the forecasting workshop demonstrated, by being aware
of the potential pitfalls and adjusting your approaches accordingly, you can still achieve
valuable results in oncology product based forecasting in China.
Simon Li
Todd Johnson and Simon Li took to the podium with two goals in mind: To identify the
unique methodological issues and market issues which impact on forecasting oncology
products in China.
Todd began by stating that the basic logic supporting oncology forecasting in China is
not too different from other therapeutic areas. However, he went on to identify several
seemingly innocuous nuances that can derail the process.
To begin with the process of forecasting in China is hampered by a limited granularity and
availability of data. IMS data, where available, needs to be calibrated to benchmarks or
(more commonly) epidemiology based forecasts need to be considered as the basis for
the forecast.
Todd Johnson
Using epidemiology data is inherent with challenges. Todd explained how Kantar Health
calculate what they term “Active Patients” (based on the number of newly diagnosed
patients and recurrence rates), in an effort to overcome the inappropriate nature of
incidence and prevalence data in relation to oncology patients.
However further challenges come when applying such rates to the population in China.
Given the huge differences in healthcare infrastructure, insurance coverage and treatment
approaches from region to region and between urban to rural locations, the forecaster
must be very careful about making any projections to “national” estimates in China.
Projection factors must be carefully managed.
In summary, Todd further identified a key business need: specialised audit data sources
focusing on product usage by indication. Whereas in the US, data at this level is widely
available, in China it represents a critical unmet need. Note that the authors expect this
to change in time as the market matures and increased data sources become available.
In the meantime, triangulation approaches based on primary research and adjusted IMS
data help to fill the gap.
Switching away from methodological issues, Simon went on to identify four unique market
characteristics which impact on forecasting in China: 1. The drug approval process; 2.
Reimbursement; 3. Pricing; and 4. IP protection.
First the regulatory pathway to drug approval often creates delays to product launches
in China as compared to the rest of the world. A 48 month timeline from filing to launch
is typical. There is a special registration pathway which can apply for some oncology
products and reduces the timeline, however the success of approval via this route is
largely dependent on the degree of influence the company’s medical / government affairs
team has with the authorities. Delay tactics can be used in some cases by administrators
which can further slow the approval process.
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Around reimbursement, the current set of “expensive” oncology treatments are self
paid by patients; insurance coverage is non-existent. This situation is evolving however
and relaxing of government reimbursement limits, as well as the emergence of private
insurance is likely to change this landscape in the not too distant future.
Being included in the National Reimbursement Drug List (NRDL) in China clearly has
a significant impact on product uptake, as Simon demonstrated by sharing a Xeolda
case study. The next round of NRDL review is widely anticipated in 2013. Any product
not included in the NRDL can always lobby for inclusion in the regional Provincial
Reimbursement Drug lists (PRDL). However the irregularity of these reviews and lack of
transparency around the process creates a challenging environment for the forecaster
when building scenarios.
Pricing strategies in China provide further pause for thought as a forecaster. Most
innovative products follow a free market pricing strategy immediately post launch but at
some point, once reimbursement insurance approval is sought, the price will become
regulated by government control and likely to be reduced. Understanding the timing and
impact of this process is critical to building a longer term forecast scenarios.
Patent protection remains a challenge in China. While securing a patent can provide 20
year protection, it is a complicated process and the application must be made before any
generic or biosimilar entry is filed. That said an alternative route is to seek a “new drug
monitoring period”, which can more easily provide exclusivity for 4 to 5 years post launch.
In summary, the paper demonstrated that while oncology product forecasting in China
remains challenging, applying the right local market understanding and methodological
adjustments via a team of experts can still result in valuable forecasting models.
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Workshop 2 Sales Force
Effectiveness
Session Chairs: Stuart Bartlett, Instar Asia and Ken Shearer, MSD Japan
Stuart Bartlett
Paper 1: Hospital Market Potential Estimate in China and its SFE Applications
Speakers: Jon Wang and Kelly Wang from ZS Associates
Jon and Kelly from ZS Associates in China gave a very detailed and insightful
presentation on how to estimate hospital size in China and why, in a market with little or
no secondary data, it is an exercise that needs doing.
They started by laying down a challenge, asking why the industry should care about
needing to estimate hospital size in China before moving onto explain how critical it
was in driving decision making for segmenting and targeting, sales force size and effort
allocation, territory design, sales target setting and performance management, in what is
today the world’s third largest drug market.
Being a hospital based system, understanding which hospitals to target in China is critical
to the overall promotional strategy for any brand or company.
Ken Shearer
ZS reinforced this point and further explained that the hospital market in China is
dominated by government owned public hospitals which treat the vast majority of patients
and dispense the vast majority of prescription medications.
Market Overview
Jon Wang
ZS also reiterated the point that within China, there is no comprehensive secondary data
available that provides accurate data on hospitals, which allows companies to understand
where they need to be focusing their promotional effort and resources.
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In the absence of such secondary data, ZS made the point that companies are forced to
rely on building regression models and projections, relying on data from multiple sources,
in order to try and estimate hospital size and potential. They proceeded to describe an
approach that they have developed that has been used successfully to define hospital
size, a critical component for sales force decision making, in China.
The start point was said to be defining the market of interest in China. Here ZS explained
that factors such as indication, molecules, brands, reimbursement status and value
needed to be taken into consideration. They explained that this stage was critical, as it
was the base for all subsequent modelling and projections, and as such that due care
and attention had to be given to this initial stage. They stated that the market of interest
should reflect each product’s brand strategy, outlining the competitive set that the
company believes their product can compete against.
They then moved onto talking about acquiring sample hospital sales data within the
market of interest and whilst more and more data sources were available, none were
comprehensive or national, and that multiple sources needed to be purchased to build a
complete a picture as possible.
Once a picture of sales data for sample hospitals had been built, the next step was to
understand the relationship between sample hospital sales and hospital profile attributes
such as number of beds, doctors, patient volumes and drug revenues. Hospital
profile information is collected by China’s Ministry of Health and provides a nearly
comprehensive list of major hospitals in China. From this relationship between known
hospital profiles and known sample hospital sales, we could then use the remaining
known hospital profiles to project market potential for hospitals with unknown
market sales.
Approach: General
ZS then explained how mathematical modelling, using linear regression, was then used
to project and build a rank-ordered list of hospitals by market potential. This could
then be used by organisations to identify where they should be focusing their sales and
promotional effort and deploying their sales reps. Two examples were then shared that
illustrated how this model had helped companies shift focus to hospitals, within a territory,
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that were not being sufficiently covered by sales reps, where in fact the potential for quick
wins was significant, as well as how the model had been used to re-deploy the sale force
based on territory level data ensuring a more effective deployment of resource.
Approach: Projection
ZS then touched on the need for the sales force to be involved in helping to refine the
model by using online or excel based formats for validating the information pertaining to
hospital size estimates, based on information that sales reps were getting from the field.
They mentioned that this not only helped in getting the sales force on-board and behind
the model and targets being set, but that this process was also critical in getting as
accurate a picture as possible.
ZS ended by referencing common mistakes made when using this approach with these
typically being the lack of attention paid to defining the market of interest at the outset
and not aligning this to the company’s overall strategy. Further problems were excluding
the sales force from the process and applying the process regardless of company needs
or market situation.
ZS also reminded the audience that this is a model that is dependent on assumptions and
data from a variety of sources in a market where secondary data is hard to come by and
does not exist at a national level. Therefore, while being powerful that it is not infallible.
They used the analogy that it is like a weather forecast, not 100% accurate all the time,
but ensures you have an umbrella when the risk of rain is high.
The paper was well received by the audience and reinforced how important investing
in estimating hospital size is in an emerging market like China, where secondary data is
limited, and how critical it is to the overall success of a sales strategy in China.
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Paper 2: Perception is reality. Measuring Sales Force Effectiveness (SFE) and the Implications
for Pharma
Speakers: Delphine Perridy, General Manager Cegedim Strategic Data and
Sebastien Gaudin, Strategic Marketing Director, Sanofi Aventis
With investment in sales force spending up nearly 25% in China, achieving sales force
excellence is more important than ever in a highly competitive and dynamic environment.
Today the pharmaceuticals industry faces the challenge of transferring acquired learning
and experience to sales organisations in emerging markets; tracking SFE metrics that
provide actionable insights is therefore essential.
Sebastien Gaudin
Fundamentals to build and equip a successful sales force:
a) A market specific sales force strategy and model based on a “market access”
approach to prescribers, patients and payers
b) A skilled, motivated and well trained sales force that is the “right size” to achieve
desired target coverage and call frequency
c) A unique, high quality product which is effective and safe
d) An up-to-date target universe segmented based on Rx behaviour
e) A multi-channel marketing mix that augments and supports sales force activity and
overall brand strategy
f)
Clear marketing messages that have been thoroughly researched, are backed up by
evidence and tested to prove they can convey the product’s benefits in a way that
distinguishes it from other existing treatments.
Execution is not straight forward and correctly measuring the effectiveness of any of these
elements is a necessary challenge.
Illustrated by a case study using CSD panel based diary audit, Sebastien and Delphine
demonstrated the importance of continuously capturing physician recall, perception of
call value and how this is linked with intent to prescribe.
In their presentation 5 drivers of Sales Force Excellence were analysed for one of the
major brands of Sanofi. This analysis highlighted the strengths and areas of improvement
of Lantus Sales Force for the following areas:
•
Sales Force Size: Over 98% of the sales calls completed in China present only one
product, therefore an analysis of Lantus sales force size was realised at the brand
level comparing its size to its main competitors.
•
Sales Force Coverage and Frequency: This analysis provided a comprehensive view
of all brands of this market and where they fit into the overall sales force structure,
highlighting the leadership of Lantus.
•
Sales Force Targeting: Measuring the quality of the physician target list is an effective
tool for improving market coverage and incremental sales. An analysis of targeting
effectiveness among frequent, occasional and non-prescribing targets highlighted
Lantus’ targeting weaknesses or strengths.
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Delphine Perridy
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•
Sales Force Call Quality: Sales success also depends on factors that could be
difficult to quantify, such as the rep’s ability to build relationships and connect with
doctors. After analysing the sales call quality of Lantus, Sebastien and Delphine
also explained the importance of “social calls” in China, the local practices, and how
they can influence the current prescription habits. The notion of “guanxi” was also
described, a very important element in the Chinese culture. It describes the basic
dynamic in personalised networks of influence, and is a central idea in
Chinese society.
•
Sales Force Messaging: This analysis gets to the heart of SFE in revealing customer
perception and feedback on a brand’s core messages. Are the Lantus messages
getting through? Is it bringing the customer value? Is it driving intent to prescribe?
The essential messages of Lantus were analysed to highlight if the messages were on
and off communication, and to identify the strengths and weaknesses of the brand’s
overall marketing performance.
This case study demonstrated the areas where Lantus Sales Force is performing
well and a few areas where they could reinforce their SFE. The emphasis was on the
importance of delivering the messages that really drive prescription intent, and on the
challenge of training and developing sales representatives in China to deliver the official
communication with professionalism. The high sales rep turnover and lack of strong
leadership skills are an important concern in China.
Sebastien and Delphine finally explained that access to a continuous audit of these
metrics is essential in driving strategic and tactical decisions that impact commercial
success. Indeed, continuous panel based diary audits have proven to be an excellent
means of achieving the above. An ongoing means of capturing top-of-mind recall and
perception of key messages linked with other call metrics can provide timely feedback
that will allow a brand team to monitor and assess the effectiveness of their efforts. This
also provides the information needed to decide if remedial action is necessary.
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Workshop 2 Methodologies
Session Chairs: Graeme Jacombs, Kantar Health, ShengWei Lam, Sanofi
Aventis and Peter Caley, Branding Science.
Paper 1: The Development of Social Media Research in
Asia Pacific - Opportunities and Challenges
Speaker: Sam Flemming, Founder & Chairman of CIC
Social media, a part of the 2nd generation of Internet-based services, has evolved to be
a mainstay of our Internet lives. A study by Nielsen Netview in USA (2010) showed that
of the time spent using the Internet, social media accounted for the single largest activity.
But what about emerging economies like China?
ShengWei Lam
The overall objectives of this session were to illustrate the evolution of social media in
China and to explore future opportunities for pharmaceutical market research using social
media. Sam showed that social media in China has both high penetration of usage as
well as diverse platforms, ranging from social networking and gaming to e-commerce.
He also highlighted that China has unique platforms (Sina Weibo, BBS, etc) that mirror its
Western counterparts (YouTube, Twitter, Facebook, etc), and that China’s netizens are in
fact more engaged in the social media arena as compared to America’s netizens - there
seems to be more creativity and innovation in terms of how social media platforms are
used in China.
China Social Media Landscape
Peter Caley
Sam Flemming
Social Media prism inspired by Bran Solis and JESS3, 2008.
Sources: Internet user stat from CNNIC 28th report.
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China’s netizens are more engaged than America’s
Set in the broader context of pharmaceutical market research, Sam showed that social
media offers a ‘goldmine’ for insights and acts as a complimentary tool to conventional
research methodologies. The interactions amongst patients and HCPs are ‘real’ and
honest discussions - besides comments and text, it’s also about emotional support
and sharing within a community. This intangible element is something which can help
pharmaceutical companies gain a better understanding of their stakeholders, i.e. the
patients and HCPs. In many ways, social media is like ethnography, it’s observational
in the sense that participants are unaware of research “presence”. Thus, the traits and
benefits that set social media research apart from the traditional research methodologies
are also similar to ethnographic research:
1. Participants are in an environment where they feel comfortable to interact with others
who share the same experiences or problems (e.g. people who have the same diseases).
2. Opportunity to gain an in-depth understanding as participants share personal
thoughts and feelings. The language used, particularly when the subject matter
resonates strongly with the individual, are often descriptive and colourful in its own
unique way.
3. It’s real-time - commentaries unfold as soon as an event is recorded.
5Ws of the Rx related IWON
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Sam went on to offer guidance on how pharmaceutical companies can obtain rich
insights from social media by identifying the ‘5 Ws’:
•
Where do patients and HCPs talk to one another and how does this differ by
therapy area?
•
What are the topics participants are concerned about and the unique culture that
is associated with discussions in the different therapy areas?
•
•
When do participants usually communicate?
Who are the people who are making an impact during discussions and how
can these people be identified (the Why as in the motivations/reasons for
their participation)?
In considering the ‘5 Ws’, it is important to understand that there is no one-fit-for-all
solution - clear distinctions need to be made between prescription and OCT categories,
as well as having a clearly defined research objective. As much as social media can be
used to mine insights, it can only be as good and relevant as the objectives on which the
design is based.
Sam concluded that there exist challenges of social media research, 2 of which are
particularly noteworthy, and which technology may help overcome in time:
•
Identifying participants and availability of demographic information - there is
currently no consistent way to ascertain the real identity of participants. In social
sites for example, there is the potential of participants making fake IDs and creating
numerous comments with a view to either increase popularity of that site or to
influence opinions.
•
Unsolicited and unstructured answers also present challenges in terms of sentiment
analysis, i.e. ability to differentiate positive, neutral, and negative comments. Text
mining capability could be a future development to address this issue.
Medefield – Success Delivered in Asia
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requirements of healthcare market research. Medefield has the resources,
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data you need through our engaged, responsive online community of
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Paper 2: The relevance of online research in Asia.
What are the opportunities and challenges?
Speaker: Robert Pollard - P\S\L Research Asia
This presentation was positioned from the start as a practical guide to the opportunities
and challenges for online research in Asia. Rather than seeing online research as the
solution to every marketing challenge, it’s aim was to present a more balanced view of
what role online research can (and should) play in solving healthcare marketing issues in
Asia today.
Robert Pollard
Are you an early adopter or a technology laggard?
The audience were encouraged first to think about the role of online and mobile
communications within their own businesses. What activities were their companies
engaged in within this space? Would they consider their companies to be leaders or
laggards in this field? How do they rank compared to their competitors? How are they
capitalising on the cost benefits of using online communications as a tool throughout
their business? With global online usage ramping up at a fast pace, technology has the
capability to change the dynamics of the world economy. With mobile internet device
sales growing exponentially, companies and individuals who do not start to embrace
these new technologies are at risk of being left behind very quickly. Executives in
the audience were advised that they should now be taking a good look at their own
organisations to ensure they too do not get left behind.
Part of this examination should focus on the role the internet has as a tool for market
research. A quick audience poll established that the majority of the audience had
personally taken part in an online survey, commissioned research, and commissioned
some of it online, however, Robert pointed out that this is not always the case in Asia. He
commented that the concept of conducting physician research online is often met with
scepticism and indifference, quoting some typical client refrains: “You can’t do online
research with doctors in Asia”, “It does not work! We’ve never tried but Asia is not like
Europe, doctors and hospitals are not connected in the same way”, “Not today! Not
tomorrow! Come back in a few years time when Asia has caught up with the rest of the
world.” He also pointed out that in his experience, smaller companies tend to be more
nimble and are taking up internet research far quicker than the big multi-nationals in
the region.
Internet access across Asia
Any appraisal of the potential application of online research needs to look at logistics.
Is it feasible to field an online survey in a particular country? Are there enough people
who physically have access to the internet to take part in surveys? General internet
populations across Asia do vary, from a low 8% of the general population in India to a
high of 81% in Korea. How does the penetration of the internet differ in the physician
population compared to the general population? Is it higher? Robert argued that where
general population internet penetration is higher, so too is the chance of conducting
online physician research, e.g in China, Hong Kong and Taiwan, Japan, Korea,
Malaysia and Singapore. He also pointed out that with bandwidth improving; it’s not just
quantitative research that’s being conducted. Researchers are also experimenting with
online qualitative research.
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Internet Population Major Markets in Asia
Placing Asian internet access into context
Robert argued that the growth of the internet in countries across Asia (growing at a rate
of 40% compared to 26% in Europe and 13% in North America)1 opens up a whole raft of
opportunities for research. He illustrated this by sharing some findings from a study into
how physicians access medical information, both in the USA, and in Asia.2 In the USA,
75% of physicians reported that they used the internet to source information - everyone’s
familiar with the concept of just “googling it” to find out what you need to know. In Asia,
the internet was used just as widely (86% reported using the internet in Asia to source
information)3. The audience was warned at this point that the statistics displayed for Asia
did show a biased sample, as those interviewed were from the major cities, rather than
the more rural physicians; however, Robert made the point that this was where in most
cases pharmaceutical companies targeted their sales and marketing activities and as
such research activity is mirroring this. For research in more remote areas alternative
solutions are perhaps more viable at this time.
1
2
3
Source: Internet World Statistics, Ref: http://www.internetworldstats.com/stats3.htm
Ref: Independent research USA with 2,200 specialists - April 2009
PSL Research in Asia Study in March 2010
How Doctors Access Medical Information - the East
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Robert then went on to illustrate the extent of internet penetration by referencing two of
EphMRA’s recent BRIC Internet Studies. These revealed a high level of internet access
among physicians from the major cities at home (96% access among those interviewed
in India4 and 99% those interviewed in China).5 He argued that when you think about how
busy physicians are in their day-to-day practice in their work setting; this provides a good
opportunity to engage with physicians when they are in a more relaxed environment.
4
Ref: EphMRA Foundation Project: Physician Internet Access (BRIC countries), India - 2011 - 248 doctors split GP,
Oncologist, Cardiologist and IM. Metro and non metro cities including Mumbai, Chennai, New Delhi, Kolkata and
others with population around 1 million. 15 minute F2F interview.
5
Ref: EphMRA Foundation Project: Physician Internet Access (BRIC countries) China - 2011 - 300 doctors from 31
Provinces / Municipalities - IMs, Cardiologists and Oncologists. 12 minute interview with 150 using telephone and
150 online.
The second part of the presentation focused on a SWOT analysis of online healthcare
research in Asia.
Strengths:
•
Speed - rapid project turnaround, real-time reporting, pre-programming for
automated analysis.
•
Amazing flexibility - online can accommodate a variety of offline methodologies,
including patient record studies, advertising testing, complex conjoint studies, and
product profile tests.
•
Enhanced data quality - without the presence of an interviewer, there is less
potential for bias or error, as well as more consistent questioning and rotation
exercises.
•
Cost efficiencies - online research removes the need for recruiters (when using
panels), interviewers, punchers, print costs, mail costs, and flight and room costs (for
qualitative projects).
Weaknesses:
•
Programming errors - once a questionnaire is in field, there is no room for error.
It is important to pilot the online survey and ensure the script is programmed by a
competent survey programmer and fully tested before it is launched.
•
Limited open-end responses - when fielded as part of a semi-structured survey,
open-end responses tend to be more limited when fielded online. Questions have to
be posed well to elicit the best response in the absence of an interviewer to prompt
the participant.
•
Limitations on the length of the survey - it is best to limit online surveys to 15
minutes, they can go longer, particularly for conjoint, but participants get fatigued
with longer surveys and will drop out. A 15 minute survey allows you to cover a lot of
ground, for example, this could cover 32-33 questions, some open-ended questions,
some demographic questions and a target product profile.
Opportunities:
•
Greater access - according to a recent survey conducted across 12 countries in
Asia, 58% of physicians access their computer for work-related issues 7 days a week
for an average of 8.31 hours. A further 34% access for 3 days or more per week for
work.6 Online provides a place for researchers to reach busy physicians.
•
Online qualitative research - this provides the opportunity for multi-location, multi-
time zone, multi-participant studies. These will work better across some cultures than
others, but provide increased flexibility and cost-savings.
•
Faster research - online enables fast turnaround research, days rather than weeks.
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Threats:
•
Continued scepticism - both among the research community itself, but also among
client-side colleagues in marketing and elsewhere in the business.
•
Data security and privacy - ensuring that research participants feel protected when
taking part in an online survey, and do not fear any external “watching” or intervention
when giving their opinion.
Robert concluded by saying that the way to get the most from your online research was
to get out there and try it. Try it for a short five minute online poll, try it for a more complex
conjoint study, try it with a more qualitative project because if you don’t try, others will,
and you will quickly get left behind.
So Where Should You Be Using Online Research?
6
Ref: Instar Research March 2011; Based on 1,892 Physicians across 12 major Asian markets - note - sample
based on major urban centres.
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Opening Speaker: David Richardson - Managing Director, Ipsos Asia Pacific
Session Chair: Bob Douglas, Synovate Healthcare
A Humble View on Our Greatest Opportunity
David Richardson opened the conference with a keynote speech about his experiences
in the Asian market research industry. He declared that the future is in Asia, and that that
the Asian boom is something everyone in the region had been experiencing for the past
20 years - year on year growth of around 20%.
David Richardson
David shared some of his personal experiences managing businesses in Asia - he
estimated that for 10 years of his career, the companies he managed grew more than
50%, for 2 years, he managed businesses which grew more than 100% and in one year
his business experienced 200% growth. This is a phenomenal rate of company growth to
have to take care of. This isn’t the past, it’s also the present; China is poised for this type
of growth for a long time to come, David declared.
He then outlined how senior management view this type of growth. If they understand
that the market will grow by 20% in the next year, setting a budget for anything less than
20% growth is unacceptable; indeed there is pressure to outgrow the marketplace and
achieve 30% growth. This is a great burden to manage. In addition, this isn’t growth for
one year, but its 20% growth year after year after year; this is a very stressful situation to
be in and presents enormous challenges.
This growth is not experienced by one agency or company, but by all companies. The
biggest challenge they all face is the fight for resources to meet the needs of the growth;
resource which does not exist. The growth rates don’t look as if they are going to stop,
but it is difficult to recruit people and to develop talent in this environment and at this
pace. It is very difficult to staff up to meet future needs.
David then explained his theory of the ‘Right time, right place’ in Asia. In 1989, it was too
early to develop a pharmaceutical research business in Asia, the knowledge transfer
from the West just didn’t work. In 1995, it was again the wrong time, as clients weren’t
ready to invest. However, in 2000, with a change in the regulatory environment, splitting
prescribing and dispensing, the time was finally right. The market took off, and everyone
was successful. The lesson learned was knowing when to do what.
In David’s view, the second major problem the research industry faces, after resourcing,
is in terms of pricing; although the two are closely interlinked. There are many
researchers who love research, but don’t demand the right prices - the cost of research
in China has not risen in line with the market. This means that the research teams either
have less money to pay themselves or less money to hire assistants to help them out and
learn the business. This ends up as a cycle of long hours and not enough people in the
teams - but for management it looks very profitable. Overworking our teams is not great
business practice. David asked that we use the profit to give our people a more balanced
life, and charge the right price for our work, and have our clients accept the right price.
A lot of Global Head Quarters are investing in China, but who is going to do the work?
Based on research he had done himself, David told the audience that he understood
that a few years ago, 40% of positions in the research division of pharmaceutical
companies in China were vacant. It is not possible to commission research if there is
no commissioning manager. What tends to happen is these client companies fill their
vacancies with people from the agency side, which then means that the work can be
commissioned, but there is no-one on the agency side to complete the work.
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In the average Chinese research agency, 30% staff churn is not uncommon. This means
that every three to four years everyone in the agency is new. Each major research
agency in the region needs to think in terms of hiring, training and developing 50 to
100 new researchers every year in China, with an understanding that only 20% of these
people will make it through. Some of these people will be hired by clients, and people will
cascade upwards.
This is a very difficult business model for Global Head Quarters, based in the West to
buy into.
In addition to lots of training, what China needs are stable structures. There are so many
job opportunities for people in China, that we need to keep them happy and to make
working in our businesses as attractive as possible. As managers, we need to think very
clearly about how to make people happy in their jobs and develop the right corporate
values and people focus to retain them.
David’s key message to the audience is that we need to carefully manage the future in
Asia and invest in resources as we go along. In our industry, it is the people who are the
future and they are the only thing that will make this industry work.
The catalyst for
successful decision
-making in the life
sciences industry
Share our catalytic ideas
Review our presentation,
Forecasting New Products
in China
Found in our resources library at
www.kantarhealth.com
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conference reports
Paper 2: Market Research in China - survive or thrive
Speaker: Hairuo Wang, Director Market Research, GSK
Session Chair: Graeme Jacombs, Kantar Health
Kick starting the first EphMRA conference in China was an assessment of the state of the
country’s pharma market research industry. GSK’s Hairuo Wang, with long experience in
commercial and research roles in both the US and China, was very well placed to deliver
a frank and honest appraisal of the challenges and opportunities.
Hairuo Wang
The dramatic growth in the China pharma market has been well publicised. A
combination of demographic, economic and social changes within China are driving
increased healthcare need and wider ability to pay, while both local pharma companies
and MNCs are investing heavily, building their offerings and expanding their presence.
This has created what Hairuo termed a Perfect Storm, combining to drive the Chinese
pharma market at a CAGR of 25% for the past 5 years, and with double digit growth likely
for years to come.
MNCs are now investing across the value chain in China, increasing their presence
across innovative and generic Rx, OTC and vaccines, with an increased focus on
launching new products from a company’s global pipeline into China. Salesforces are
expanding rapidly and far beyond the largest Class III hospitals of the ‘big three’ Tier
1 cities (Beijing, Shanghai, Guangzhou). The government’s moves towards universal
Graeme Jacombs
coverage and benefit improvement is unlocking substantial new market space in smaller
hospitals and in Tier 2, 3 and 4 cities and the rural markets, with an estimated value of
RMB250 Bn each year.
Substantial new market space
Everything is growing quickly: the market, the competition, pharma companies’ portfolios
and their ambition. All these have combined to create an increasing need for high quality
customer insights and market intelligence. In China a greater understanding of the
market opportunity and customers’ needs provides a genuine competitive advantage at a
time when pharma companies are increasingly looking to the country to deliver growth.
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In response, within pharma companies the market research function has become more
central and established. Projects have become increasingly complex and methodologies
more sophisticated - shifting from mostly validating and tracking in nature, to strategic
assessments and foundation research, such as patient segmentation and business
opportunities exploration. Involvement (and scrutiny) has grown, from stakeholders
both within China and at headquarters level. Not surprisingly, budgets have also grown
substantially - based on informal feedback from agencies, Hairuo estimated that the
established research agencies in China have experienced a phenomenal 30-40% annual
growth over the last 5 years, in revenue, numbers of projects and staff.
And so we come to the challenges. For while the need for high quality research has
increased massively, resources and capabilities have not always been able to keep
up. The number of research agencies and, more importantly, the number of senior
experienced consultants at those agencies, have only grown slowly. The result has been
researchers each handling a larger number of increasingly complex projects with an
inevitable impact on quality. At the same time, Hairuo has observed what she considers
significant gaps in some fundamental research skills, particularly regarding researchers’
abilities to define business issues, understand client’s perspectives and appreciate how
insights will be used to drive decision making. Data rather than understanding is too
often the result.
Allied to this has been the development of something of a commodity mindset, with
research sold by the interview and insufficient focus on delivering added value. The issue
is best seen in one dramatic statistic: that the average cost charged for a focus group in
China has been unchanged from 2006 to 2011. This in an environment where the cost of
everyday living has increased year on year by about 25% in each of the past 5 years.
Echoing the situation in Western markets in the past, market research is yet to be
recognised as a career in China, but tends to be regarded as a first job out of school
and a stepping stone to other opportunities. There is a need for more well defined
career development and greater investment in training, a situation both caused by and
contributing to an alarming 30-40% annual turnover rate in many agencies. A further
factor is the prevailing mindset, characterised in a recent issue of the magazine New
Weekly in which it described China as “The Nation in a Hurry”, impatient for success and
the financial rewards it brings. Market research may not be seen as the quickest route to
such fame and fortune.
The situation though is far from bleak. The need for high quality market research
is continuing to grow as companies expand, new sectors emerge and marketing
approaches develop. The opportunities presented to young researchers are
considerable. Business leaders, both local and expat, are open to new ideas and the
value and insight that market research can provide. There is a huge young talent pool of
highly intelligent and hard working young people, ready to be trained.
Market research in China is entering a critical stage in terms of both capability and talent
development if it is to meet the increasing demands of a dynamic market. Opportunities
exist on many fronts for market research to make bigger impact, demonstrate greater
value, and grow into a sustainable business.
What is needed is increased focus within both pharma companies and agencies on
establishing market research as a career, investing in training and core skills, and
delivering quality consultancy that genuinely addresses business issues. It is up to the
industry’s leaders to work together to make this happen.
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Paper 3: Capitalising on the opportunities for premium priced therapeutics in China
Speaker: Mandy Chui, Center of Excellence Leader, Price & Market Access, Asia Pacific/Japan, IMS Consulting Group
Session Chair: Frank Guo, Synovate Healthcare
Mandy Chui
We are seeing massive growth in the Chinese pharmaceuticals market - over the next
5 years China is predicted to grow by over 40bn USD and is estimated to become the
world’s number 3 pharmaceutical market after the USA and Japan. The growth in China
is being fuelled primarily by generics and off-patent originators, i.e. lower priced products
- in 2010 only 6% of sales in China was attributed to patented products - compared to
62% for generics.
Global growth is being driven by premium-priced speciality products such as oncologic
and biologic therapies but this is not the case in China where patient inability to afford
these NCEs means that multinational companies (MNCs) promoting them face significant
challenges here. Almost no premium priced products are reimbursed at a national level,
however there is a move towards some regions offering reimbursement in advanced
specialised hospitals located in developed urban areas. However even in these
instances there is still a large patient co-pay. To illustrate the point Mandy highlighted
that the price per month of select biologic agents can reach over 5,000USD - in
comparison to the average monthly household income of just 850USD.
Frank Guo
There is an expectation that the health reform in China will improve access for premium
priced speciality products - but Mandy pointed out that this might not yet be the case as
the focus is currently on primary care so as to ensure that basic medical care is available
for the mass population.
To offer further illumination, Mandy outlined the 5 key criteria for developing a winning
strategy for premium-priced products:
1. Disease prevalence - governments must be ready and willing to include the disease
in their health strategies. MNCs should strive to capitalise on the opportunity for
products which have high local demand and unmet medical needs. For example Hepatitis B - China has the largest patient population in the world and similarly
lung cancer has the highest incidence in China resulting in high demand for
effective therapeutics.
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2. Awareness / Diagnosis - not all diagnostic tools are available in all hospitals and
so many diseases are underdiagnosed and treated. MCNs may need to promote
diagnostic tests as part of their adoption strategy as well as provide training on the
use of appropriate diagnostic tests.
3. Access to care - patients need to know where to access care and MCNs need to
understand which cities/provinces are willing to adopt favourable reimbursement
policies. In the absence of reimbursement. MCNs need to build market presence
and develop strategies to optimise penetration in current market conditions.
4. Affordability - how can the MNC access those patients who can afford to pay and do
patients understand the value the drug can bring? Innovative strategies need to be
considered to increase the affordability for premium priced products.
5. Willingness to pay - China is expected to become, in 2015, the single largest luxury
goods market in the world - surpassing Japan. Chinese consumer affordability
continues to rise as reflected by the expansion of the luxury market. For MCNs
it is important to communicate effectively the value of their products and change
physicians and patients’ perception in order to improve their willingness to pay for
premium priced medicines.
So, the challenges are clear and Mandy’s advice to MNCs? Define consistent goals and
evaluation criteria for speciality products in China, both in the short- and long-term.
MCNs need to ‘lead and shape’ in order to win the battle ground for speciality products playing an active role and setting realistic strategic goals.
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Paper 4: Korea - Another BRIC in the Wall
Speakers: Jinkyung Kim and Seon-Young Kang - Ipsos Health, Korea
Session Chair: Diana Tan, IMS Health
Jin and Seon-Young presented an engaging paper to the conference showing the
importance of Korea in Asia and why it deserves to be in the consideration set of the
other pharma-emerging markets. Their paper focused on three key issues in Korea and
showed the impact of these changes on market research.
Jinkyung Kim
Jin started with an introduction about Korea, how while it is a relatively small country,
certainly compared to China or the US, it has a large population. In land mass, Korea is
one hundredth the size of the US, and has one sixth of its population (around 48 million).
Korea is a highly academic society; 79% of Koreans go to university, compared with only
46% of people in Japan or 65% in the US. It ranks 10th in the world in terms of internet
usage rates (above the US) and is second in smartphone usage. As Jin pointed out,
Korean people like to both set trends and be at the forefront of emerging trends. As an
example, she explained that many people in Korea do their banking via their phone and
in many outlets you can pay for goods without money, using smartphone technology.
This widespread interest in and use of smartphones has inevitably had an impact on the
use of landlines in Korea. Fewer people are registering landlines with the Yellow Pages,
therefore it is getting more difficult to do conventional random telephone sampling. Jin
Seon-Young Kang
explained that in 2010, the penetration rate of cell phones in Korea is over 100%, as many
people have several handsets.
The Korean healthcare system offers a high quality service to the population. Most of the
hospitals in Korea are clinics, which allow patients direct access to specialist care. The
primary care concept is not developed in Korea.
And we have a high quality health care service
Diana Tan
The drugs market is dominated by multinational pharmaceutical companies, as opposed
to local manufacturers. Only three of the top 10 drugs are produced by Korean
companies (DongA, Hanmi and Daewoong). Korea is ranked 15th by IMS in terms of
drug sales, and the 4th largest market in Asia after Japan, China and India. Jin explained
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her view that the growth in the Korean drugs market will be led by generics and biologics.
Oncology products are in a leadership position in Korea, while generics are in a supergrowth period.
Growth is expected to be led by Generics and Biologics
Having provided the audience with a thorough understanding of the Korean market
setting, Seon-Young then gave her view on three key issues which are affecting Korea
today. Firstly the issue of patent expiration; which is a common problem around the
world. She showed data illustrating that the generics market in Korea will exceed 20%
of drug spend, which is one of the highest in the world. However, in Korea, there are
key differences in terms of preference by hospital type; general hospitals (which have
more patients) have a preference for branded drugs, while clinics prefer generics. This
provides pharmaceutical companies with a basic, but clear market segmentation. SeonYoung argued that the branded market is relatively secure in Korea, due to this hospital
preference, and the simple fact that Koreans like brands, irrespective of the product.
In addition, unlike other markets, the price difference between branded and generic
products is not that great, only around 20%.
Seon-Young then went on to explain the growth drivers in the Korean market; namely
biosimilars. She showed that the rapid growth in the market is mainly driven by biologics.
This is also encouraging local Korean companies to enter the drug market, for instance
Celltrion, which is about to launch a Herceptin biosimilar. In addition, non-pharma
companies, such as Samsung are also investing heavily in biosimilars.
The last issue the audience were shown was the change in population structure in
Korea, which has the lowest birth rate in the world, and a rapidly aging population. This
inevitably places a great deal of stress on the healthcare system and generates changes
in the structure of that system. For instance, between 2005 and 2009, more OBGY clinics
were closed than opened, unlike geriatric clinics, which have seen a huge increase over
the same period. However, in terms of paediatrics, parents in Korea are keen to spend
money on their children’s healthcare. For instance, there is a high demand for quality
paediatric vaccines, such as Prevenar-13. Over 70% of children have been inoculated
against pneumococcal disease - which is a very high rate across the AsiaPac region.
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The rapidly aging population inevitably has a negative impact on healthcare budgets.
Over 30% of medical costs in 2009 went to those over the age of 65 (vs less than 20%
in 2002), while the government is predicting a deficit in the health insurance budget for
2011. This means that their key objective is to cut costs. Major price negotiations have
started in chronic disease areas, such as HTN and dislipidemia, and this is expected to
extend to diabetes and osteoporosis in the next 3 years.
Jin concluded the paper by showing the impact of these key drivers in the Korean
market on market research. Firstly she demonstrated the decline of telephone as an
efficient methodology. Based on work done by Ipsos Health, she showed a test study,
where 10,000 random calls had been made for research. The connection rate of these
calls (where someone answered the phone) was only 38%, after basic screening and
refusal rates less than 1% of the contacts resulted in a successful interview. This is
not an efficient approach for research. As internet penetration is so high in Korea, for
consumers and therefore patients, online research is the most appropriate methodology.
Koreans are comfortable online and used to completing surveys. For example over 40%
completed the national housing census online in 2010, which was a world record. For
healthcare professionals, online research is increasing in popularity, but it is not quite
there yet. Korean doctors are familiar with online, but given the size of Korea and its
concentration in 4 major cities, in person interviews are very easy to set up. In addition,
culturally, physicians like this type of respectful approach. Jin explained that online is
gradually being adopted and over the next 3 years she expects it to grow in popularity.
Jin recommended that any study in Korea includes some understanding of the pricing
environment. With an election around the corner, and price pressures on the health
budget, key stakeholders are changing their guidance on a regular basis.
Seon-Young concluded the paper by explaining that in her view, Korea is a growing and
vibrant economy which is attractive due to its advanced technological culture and brandcentric consumerism. Like every country in the world, it faces its own demographic and
structural issues. She urged the audience to consider Korea, despite its small size, as a
crucial market in Asia - in her view, we should all be thinking in terms of BRICK.
get in touch
If you have any enquiries, suggestions
or feedback, just phone, fax or email us:
Bernadette Rogers, General Manager
Tel: +44 (0) 161 304 8262
Fax: +44 (0) 161 304 8104
Email: [email protected]
www.ephmra.org
28
If you
have any
enquiries
conference reports
Paper 5: Ant or grasshopper? Understanding the Chinese consumer
Speakers: Marc Yates and Kah Huey Loh, The Research Partnership
Session Chair: Amelie Lan, Sanofi Aventis
Are Chinese consumers really the ant like type, who put resources aside for when times
get hard or are they increasingly mutating into grasshoppers? This interesting paper
looked at how the Chinese consumers are evolving in this ever growing market and tried
to bring a more realistic view on the preconceived ideas people may have on the Chinese
market. This was achieved through an interesting patchwork of sources that all focused
Marc Yates
on looking at the evolution of Chinese consumers: comparing them with consumers and
patients from the western hemisphere, looking at the emerging new trends identified
by consulting groups, and bringing light to the Chinese healthcare reform; how it’s
implementation will possibly change the healthcare landscape and how Chinese patients
get access to treatment.
It was quite revealing to find, for instance, that Chinese patients seem more involved
and self aware about their disease, take a more proactive and engaging role, and are
in general, less satisfied in the healthcare system than some of their European and US
peers. One of the slides presented by Kah Huey extracted from the “living with Diabetes”
study, showed that Chinese diabetic patients seemed far more aware of their Hba1c level
than their Western counterparts.
Amelie Lan
Greatest self-reported awareness of HbA1c in China
Kah Huey Loh
This can partly be explained by how the China Healthcare system and Healthcare
institutions have been set up historically: a much higher out of pocket contribution to
treatments, a system where most resources (both human and financial) were unevenly
allocated across public institutions (and mainly directed to Top level hospitals),
and a rather unregulated Hospital access for Chinese residents resulted in patients
concentrating at top hospitals to seek treatment from top specialists for even the most
common chronic diseases. Undoubtedly this led to far less available doctors, who often
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only have a few minutes to grant to each patient. There is therefore a greater tendency
for Chinese patients to need to rely more on themselves and be more engaged in their
disease management if they care to improve, maintain their health.
But this is all changing and the government’s willingness to reform the system is prone to
lead to many mutations, some more foreseeable than others, on the habits and practices
of the Chinese consumers. That, combined with the changes fuelled by a growing
economy and hence, an increasingly large population with increasing spending power
will lead to new trends in consumer behaviour, patient needs and expectations towards
the pharmaceutical industry, that we have yet to discover, understand and act upon.
Marc articulated these changes around 3 main pillars:
1. Convenience, and the increasingly demanding Chinese consumers
2. Affluence and the emergence of new pockets of high disposable income populations
across the country
3. Access and the strong government willingness to provide basic medical care to all
and to build a primary care system
Three most important changes
To illustrate the topic of Affluence, Marc showed a very interesting study done by the
Boston Consulting Group on the evolution of China’s population and the emergence
of what they called “Middle income and affluent Consumers” (MACs) who have similar
disposable income greater than in Shanghai (known as the city of reference in China
for consumer elite and trend setters). In order to reach these consumers, Multinational
companies needed to increasingly expand they business coverage as many of these
consumers were found in cities outside of the Top cities, where MNC business is
usually concentrated.
Surely, China is one of the most difficult markets to predict, there is a universal agreement
among those who know and have worked in China that this amazing country is like trying
to understand a place as diverse as Europe, others push the parallelism even further to
say that, to be more accurate, one should probably add Africa to the equation. One thing
is for sure, we still have a long way to go to fully grasp the complexity and fast changing
behaviour of the Chinese consumers, and multinationals who wish to maintain or expand
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their influence in this market will need to put efforts into constantly monitoring and seeking
understanding so as to adjust their strategy to stay on top of the game. Thanks to Marc
and Kah Huey, this paper put the finger on a couple of essential points and interesting
trends that gets us a little closer to understanding what mutations and possible new
consumer segments will rise from this transforming environment.
Middle Income and affluent consumers
(MACs)
Ipsos
Health
Ipsos
Health
Ipsos Health is a worldwide group
of healthcare experts who focus on
understanding the multiple stakeholders in
the market. We are proud to be an active and
vibrant global community, exchanging ideas
and supporting our clients’ best interests.
Ipsos has recently completed the
acquisition of Synovate, making Ipsos
the third largest global research agency.
We look forward to delivering even better
pharmaceutical research together for our
clients at Ipsos Health.
For more information
Please contact Sarah Phillips
[email protected]
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31
25/10/2011 12:58
conference reports
Paper 6: Identifying new business opportunities in China’s low end market
Speaker: Jamson Huang, Livingston Market Consultants
Session Chair: Frank Guo, Synovate Healthcare
With the recent further expansion of the healthcare insurance coverage in China - now
covering up to 90% of the Chinese population (1.25 billion), pharmaceutical companies
in China are seeing an even faster growing market fuelled by a surge in patients going to
hospitals that have been newly added to the insurance coverage.
Jamson Huang
The next five-year plan (12th five-year plan) shows that there is an opportunity for
pharmaceutical and medical device companies as there is an anticipation that hardware
and software will be improved in low end areas.
Jamson in his paper showed the audience several core unmet needs of hospitals in the
low-end market. The needs can be categorised into 3 groups i.e. needs on hardware;
needs on software and other needs which are illustrated on the below diagram.
First, understand the un-met needs of hospital
Jamson then illustrated and explored a hierarchy of needs of HCPs working in hospitals in
the low-end market. The biggest need amongst medical professionals in these hospitals
is the lack of academic training and therefore a lack of professional development credits
that are necessary for promotions and this has led to an identity crisis and a lack of self
confidence amongst physicians. In addition, the low level of financial compensation is
also one of the core unmet needs of these HCPs.
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Then, understand the un-met needs of physicians
In his paper, Jamson also discussed some activities that pharmaceutical companies
can undertake, requiring a modest investment but might result in a better ROI. One of
these examples that Jamson gave is “missionary impact” which refers to counterpart
support relationships between tier III hospitals and county-level hospitals. This involves
a physician or missionary coaching and supporting as many as 30 local physicians and
this peer support mechanism can provide vital encouragement in tier III. The opportunity
for pharmaceutical companies is that instead of having to visit all the county hospitals,
they can influence the missionaries so that they can encourage adoption and usage of
their products in local regions. Other examples that Jamson gave include supporting
physicians publish clinical papers as well as help with basic needs such as providing
facilities and tools.
In the paper, Jamson also outlined some of the hot market research topics as well as
challenges that MR agencies are facing.
Key hot market research topics and challenge of MR
The paper concluded with the positive answer as to how large the potential is and
pointed out that the needs of the HCPs working in hospitals in the low-end market do vary
substantially from their counterparts in the more developed areas.
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Paper 7: Putting Patients First
Speaker: K Nagendra Prasad, Head of Business Intelligence, MSD Pharmaceuticals Pvt Ltd
Session Chair: Amelie Lan, Sanofi Aventis
Paper only available on EphMRA website.
K Nagendra Prasad
Paper 8: Think you know your physicians? Think again! Implicit-explicit positioning for Western brands in an Asian market
Speakers: Soumya Roy, Hall & Partners Health and Shanice Lam, Qualitative Specialist, Hall & Partners-Jigsaw, Shanghai
Session Chair: Stuart Bartlett, Instar Asia
Soumya Roy
Shanice Lam
Understanding physician response to brands is a key area of inquiry in pharmaceutical
market research. The ultimate goal is to develop a motivating and compelling message
platform that emotionally engages physicians with a brand. In today’s global landscape,
pharmaceutical companies are challenged with adapting Western brand message
platforms to the needs of the Eastern audience. Moreover, therapeutic categories have
become increasingly complex, fragmented, and competitive with an influx of targeted
therapies, personalised medicines, and biologics with complicated mechanisms
of actions. As a result, defining a clear positioning with a set of winning messages
that differentiates a product in a global market place has become increasingly more
challenging. Pharmaceutical marketers have started to dig deeper in search of underlying
values and motivations to ensure that their platforms deliver on emotional or more
subliminal benefits and truly bond with target audiences in the West as well as in Asia.
Soumya and Shanice outlined a unique methodology and provided a case study for
combining physicians’ implicit responses to brands with explicit reactions that would
allow pharmaceutical market researchers to better understand underlying motivations and
perceptions around brands and new concepts. Utilising implicit and explicit responses
with oncologists in the US and in China, Soumya and Shanice demonstrated that not
only does the implicit-explicit methodology apply across western and eastern markets,
it actually does a better job than an explicit technique alone when it comes to identifying
cultural differences in associations and perceptions about brands between US and
Chinese physicians.
The roots of the implicit-explicit technique presented by Soumya and Shanice come
from research by social psychologists in racism and homophobia. The basic principle
behind this technique is to compare and contrast respondents’ explicit responses with
implicit reactions to a brand and its specific messages. The ultimate goal is to identify a
positioning and a set of messages that captures both the direct associations (what the
physicians ‘say’ they associate with brands) and their indirect perceptions (what they ‘feel’
towards the brands). The explicit method utilises conventional techniques for capturing
physicians’ reactions. The implicit technique is based on a measure of “speed of response”.
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conference reports
Soumya and Shanice draw their ideas from prior research which demonstrates that when
respondents associate one set of ideas, concepts or statements with another, “speed of
response” is often a better metric than the “actual direction” (i.e., “yes” or “no” that they
are associated; or a scale of agreement) for eliciting respondents’ true beliefs. This has
been observed to be true in associations about people (e.g., in the context of racism and
homophobia) as well as brands (e.g., associating brands with specific attributes).
The case study presented by Soumya and Shanice validates this methodology for
pharmaceutical brands with physicians’ responses to positioning and messaging both
on explicit and implicit parameters. The case study also shows that this methodology is
particularly valuable for eliciting subtle differences in motivators and messaging needs
among Western versus Asian physicians.
Ultimately the implicit-explicit technique is meant to enable the brand teams to build
a positioning platform that is based on not only on what the physicians say but also
what they truly feel and believe in, taking into account cultural differences in positioning
Western brands to the Eastern audiences.
Using IRT to evaluate brand perceptions
The case study is based on self-funded research among 225 oncologists in the US
and 105 oncologists in China. The 25 minute online survey is structured in two broad
sections: 1) a landscape analysis, where respondents evaluate three in-line brands in
colon cancer on a number of dimensions using the implicit-explicit technique; 2) a new
concept evaluation, where physicians are exposed to three new positioning concept of
fictitious but realistic new product in colon cancer in a monadic design and are asked
to evaluate the concepts on the same dimensions as the landscape analysis. The
dimensions included both clinical benefits (such as, efficacy, safety, etc.) to emotional
associations (such as pioneering, powerful, etc.).
The results of the landscape analysis show that while explicit responses reveal very little
differentiation between brands (Avastin, Erbitux, and Vectibix), when implicit analysis is
combined with explicit analysis, the leading brand in the market, Avastin, is associated
with clearer and stronger functional benefits amongst the US oncologists. In China,
a similar pattern emerges. When only explicit responses are evaluated, none of the
brands show an edge with a set of differentiating attributes. However, when the implicit
analysis is combined with explicit analysis, we see a clear differentiation and a more
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conference reports
comprehensive image for Eribitux, a brand that is better liked in China compared to
Avastin. Across both markets, the implicit response (speed of response) appears to
reveal more embedded and deep-seated convictions.
The results of the new concept evaluation are interesting and thought-provoking. The
three concepts evaluated in monadic design are based on the following themes:
Patients staying active for longer, Confidence based on science, and Powerful control (to
physicians). As in the case of the analysis of in-market brands, the explicit analysis shows
very little ‘differentiation’ between concepts both in US and China. When the additional
layer of implicit analysis is introduced, we see that physicians associate more benefits
with Concept 3 in the US (powerful control to physicians) but Concept 1 (patients
staying active for longer) in China. Moreover, we find that implicit analysis elicits more
emotional associations with preferred concepts among Chinese oncologists relative to
their US counterparts.
US v. China
In conclusion, Soumya and Shanice emphasise that combining an implicit technique
with an explicit methodology creates a better understanding of physician relationships
with brands, reflecting true convictions and strength of beliefs with existing brands in the
market. It also identifies clearer differences between US and Asian markets. For concept
testing research, IRT enables us to achieve a more clear differentiation among concepts
in both US and China with clear implications for messaging.
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Paper 9: Patient Experience Management: A new perspective to patient strategy
Speakers: Paul Zhou, Managing Director and Matthew Lu, Senior Consultant, Illuminera Strategy, China
Session Chair: Diana Tan, IMS Health
Based on some excellent research done with patients and physicians - Paul Zhou and
Matthew Lu from Illuminera, presented a paper that delineated a gaping white space in
the industry centering on the patient management experience. Specifically - how reticent
physicians and silent manufacturers are hurting not only patients’ health outcomes but
also the chances of drug success.
Paul and Matthew began by building their case on how patient power is a growing reality
in China: more and more patients refuse recommendations from their physicians while an
increasing number of physicians are hesitant to provide firm prescriptions to their patients
- preferring instead to offer them with options from which to choose.
This trend towards patient power is not just a phenomenon where patients take the
initiative to become more assertive in their choice of treatment. Interestingly, physicians
themselves are willing to “cede” power to their patients for fear of being questioned. And
in some instances, high patient loads make them too busy to spend the required amount
of time on guiding and tailoring the treatment option to individual patient needs.
•
•
•
•
Easy access to information via the internet and mass media…
Word of mouth among disease peers…
A growing distrust of physicians as news spread of scandals and kick backs…
And the very high cost of medicines - especially for chronic diseases…
Are all contributors to patient empowerment - and consequently to the choices they make
on their treatment.
Manufacturers are also largely silent.
Citing a case study of a best in class patient compliance program, Paul and Matthew
showed that over 65% of users of a drug were not “touched” by the manufacturer
throughout their drug use experience.
While physicians are largely passive during treatment,
manufacturers and not of help either...
37
Paul Zhou
conference reports
Leaving patients largely on their own to decide on which medication they want to be on,
can have significant negative repercussions.
Notably, compliance goes down as patients are unable to manage side effects.
Patients don’t get better.
They are unable to effectively assess the price-value benefit, “Why is its price several
times compared to other drugs? I suppose its efficacy is not several times of those drugs,
then what actually is its advantage? I asked the physician but he just vaguely told me it’s
‘better in efficacy’.”
They also sometimes take into account, disproportionately, the service experience over
the product benefits, “This is awful! I paid for ABC brand which is quite expensive. Yet
they give me an icebag with the logo of a much cheaper brand”. And with good reason
too - as patients are ultimately consumers who for the equivalent amount they spend on
drugs, are awarded VIP status, lounge access, golf packages by mobile phone and credit
card businesses, eager to keep them as loyal customers.
There is therefore a gaping white space in engaging patients throughout their treatment
journey. Illuminera argues that influencing patients at each of the key milestones through
active management of their experiences can lead to better brand performance. They call
such management the Patient Experience Management (PEM).
The PEM model, illustrated below, provides pharma manufacturers with a framework with
which to engage patients to achieve their target brand objectives.
A Framework to guide the formulation of a PEM strategy
The PEM approach will however need to be tailored to business goals and will be
determined by 3 main considerations:
•
What does brand hope to achieve?
•
What value story needs to be told?
•
And to which segment of the patient population?
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conference reports
A brand hoping to drive initiation would need to consider a PEM approach focused on
•
Patient education
•
Side effects management
•
Polished service experience (packaging, goody bag, events and activities, etc)
While a brand looking to improve retention rates would look more to
•
Efficacy visualisation
•
Reinforcement of QoL improvements
•
Generating a higher number of patient touchpoints
•
Events, activities, VIP status, loyalty programmes, etc
The rewards of engaging with patients in such a structured manner has considerable rewards.
As patients begin to feel cared for through more constant value-based interactions, learn
to manage any side effects from their treatment regimes and understand the value-price
justifications of their medication, companies can expect to see higher patient initiations,
retention rates and positive word of mouth.
In just over 3 years, the China market will grow to just under US$130 billion. Companies
aiming to grow their share in this dynamic market need to harness the Patient Power
movement that is clearly gaining momentum.
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Tracksalesforceandmarketingactivitywithprovenpromotionalbenchmarkingmetrics.
Patient Database
IdentifyanddevelopnewmarketopportunitieswiththeleaderinrealLongitudinalPatient
Data&PatientDatabaseSurvey.
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Evaluatetheimpactofyourcommunicationandbenchmarkitagainstcompetitors.
Primary Market Research
Go one step further to fully understand your market: Investigate the opportunities initially
identifiedwithCSD’ssecondarydatabases.
Medical Research
Accessalltheservicesofaclinicalresearchorganisationincludingbiomedical,
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39
agency fair
Over the lunch breaks the Agency Fair was open and delegates visited the
booths and agencies were able to show case their services. Here’s some of
the exhibitor feedback:
‘The agency fair was a great opportunity for the Ipsos team to meet new and old clients
and contacts. We found it gave us a great platform to talk about what we do in specific
countries as well as across the Asian region. It was well organised, and very easy for us to
organise our stand - given the contacts we made, we felt it was well worth the investment.’
Sarah Phillips - Head of Health, Ipsos
“GfK was thrilled with the overall experience in Shanghai; we enjoyed a top-quality
program, engaging discussions with excellent representation from clients – and in general,
the enthusiasm for the bright future we can build together in Asia was palpable. The
agency fair was particularly excellent, drawing interest from clients eager for information.
GfK was thrilled to be among the first exhibiting and will certainly plan to be with EphMRA
in Asia every year moving forward. Thanks EphMRA for filling the void in Asia for such an
excellent forum for education and collaboration!”
Jessica Makovsky - Vice President of Global Communications, GfK HealthCare
“Medefield has a significant presence in Asia. With a team of over 40 people operating
across 4 offices in the region (including Shanghai), and a physician community spanning
12 countries, it was important for us to showcase our capabilities at the Asia in the
Spotlight conference and meet with both clients and prospects in the region. Exhibiting
at the agency fair gave us the opportunity to meet face-to-face with clients and discuss
their needs in more detail. The conference was an exciting and worthwhile event in a very
dynamic market.”
Asif Javed - Group President, Medefield
“A good opportunity to catch up with fellow colleagues and latest market development.”
Jigsaw / Hall & Partners
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agency fair
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conference
conference sponsors
reports
EphMRA wishes to thanks the 2011 Conference Sponsors for their
generous support.
Cegedim Strategic Data
Sole Sponsor: Conference Programme
Facta Research, Inc.
Sole Sponsor: Badge Holders
GfK Healthcare
Sole Sponsor: Notepad
Ipsos
Sole Sponsor: Agency Fair Guide
Kantar Health
Sole Sponsor: Conference Pens
Medefield
Sole Sponsor: Conference Bags
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BRIC internet access study
A summary presentation was given at the conference of the BRIC Internet Access
Study conducted amongst physicians in 2011. This was an EphMRA sponsored study
supported by partners Medimix, Top of Mind and Evaluserve.
The project objectives were:
• To understand the extent and nature of usage of the internet among physicians, at
home and at work
• To guide market researchers in the most effective ways to design and conduct
research over the internet in these countries
And the main research objectives:
• Evaluate the level of availability and usage of the internet by physicians
• Evaluate physicians’ experience with online research and their attitude towards
future participation
• Identify key drivers and barriers to participation in online research
• Identify the characteristics of an online survey that would be most likely to
drive participation
The sample was:
Sample
The study covered a wide range of topics from current and future market research
participation to the type of internet connection (broadband) and the time of day online
market research surveys were undertaken.
Market Research Participation
The full study results are freely available to EphMRA Member companies.
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RELIABILITY
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A+A is one of the most experienced healthcare agencies of reference for these
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in at least 15 emerging markets each week (across a total of 45 countries).
We are constantly identifying, evaluating and training a selection of top
local partners to our strict quality standards. Our established quality control
procedures are applied with appropriate adaptations to ensure that local
constraints are not overlooked.
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suggestions and recommendations are based on a strong foundation of
rich industry experience.
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