Stop only asking if patients will use a new treatment, and start looking for their unmet needs

For this article in the series I spoke with Sam Sturgeon, Hall & Partners’ Head of Marketing Science. Sam heads up our analytics division and I chose to interview him because his team’s focus is so often on analysing what drives change and use of products. As an added bonus, Sam has worked with and been trained by some leading thinkers in this space, such as Anthony Ulwick and Clayton Christensen, the founders of the Jobs-to-be-Done Theory.

Sam and I explored the drivers of use of new innovations – in pharma’s case, new treatments – to (a) challenge our habit of assessing future use solely via asking what percentage of patients will you use this treatment in? and (b) to find a better approach to testing the potential for new products.

Sam’s answer started by referencing Anthony Ulwick, who states that, to be successful, new innovations (whatever the industry) need to allow someone to complete, or find a better way to complete, a process that previously they couldn’t – in other words, the buyer ‘hires’ the new product to complete a ‘job’ that they couldn’t do without it. This occurs when the innovative product demonstrates a significant improvement on at least one core unmet need. This requirement to meet an unmet clinical need is further accentuated in pharmaceuticals, as it is this that is used as justification to persuade payers to reimburse or fund new treatments.

Sam and I started our discussion by talking about how, when we are asked to test a product or understand how a patient journey or market may change, we believe that it is critical to understand the unmet needs of an area. This includes those that are less than obvious (such as social and emotional needs) in order to assess the potential use of product profiles. As it is these unmet needs that often are strong drivers of change.

By taking this approach – ensuring the questions are asked in the right way and with the support of trends – we believe that the ‘unmet need insights’ we uncover can offer the following three benefits:

1. Providing thought starters for positioning for new products.
2. Ascertaining the future clinical endpoints that could allow a new treatment to stand out once it is launched. We believe that significant evolution in endpoints (particularly secondary ones) is likely to occur in the next 3–10 years, as patients’ needs come to the fore and the knock-on impact of illness is recognised. As an example, the secondary endpoint of ‘impact on sleep’ (and hence concentration spans/ability to work, etc.) could become an important differentiator for treatments in all illnesses where symptoms disrupt sleep – whether it be a cough, spasm or fever.
3. Identifying effective concomitant digital health tools or diagnostics that could support, or even drive, the use of the product

Sam is a strong advocate for thinking frameworks, such as Jobs-to-be-Done, as they work extremely well at providing a structure to understanding people’s unmet social and emotional needs alongside the more obvious functional needs. And it is often these softer and, arguably, hidden needs that can have a large impact on overall product use. They task us to think more widely about a decision and hence the unmet needs associated. They can also get us to think differently about the challenge. This is well demonstrated by one of Clayton Christensen’s early examples of his framework in action: a McDonald’s branch had discovered that they had particular high sales of a thick milkshake in the mornings, but did not know why. His finding with the JTBD approach was that the milkshake was meeting local commuters’ unacknowledged (and unmet) need for a breakfast that (a) took them a while to consume (thus making it feel fulfilling during the long and boring commute) and (b) kept them full until lunchtime.

Sam highlighted a great example in pharma, as for many disease modifying treatments (DMTs) that either slow or stop disease progression, compliance can be an issue. Looking at the patients’ unmet needs can help us answer why this is:

1. Patients’ #1 unmet need is to feel better – something DMTs frequently don’t offer.
2. Often the second most important unmet need Sam has seen in his analysis is the offer of hope, and the sense that things will get better – for which patients require regular evidence to see that the treatment is actually working to keep them motivated to take the treatment.

Could a way of tackling compliance via answering this second unmet need be to provide sources of evidence for patients that clearly show that the treatment is working and making things better or, at least, stopping them getting worse? To take this example further, Sam discussed how in Type 1 diabetes we know that the challenge of regular treatment administration, especially through painful infections, is hard and the threat of damage to organs from uncontrolled glucose levels seems far away. As such, the temptation of oh well, if I miss this dose, it won’t make any difference can easily kick in. This is especially the case when the evidence of disease control, and efficacy of the treatment, takes the form of a (HbA1c) blood test a few times a year; this provides no granularity around the impact of a single missed dose, and the feedback is too far away in terms of time from when the person skipped the dose. In order to drive patients’ hope that things are getting better, the evidence needs to be much more regular, and received much closer to when the treatment is taken. This would then act as a strong compliance motivation – as demonstrated by continuous glucose monitors that show how the insulin is controlling glucose levels.

If we are to take this new approach to assessing product potential, instead of relying solely on answers to how much will you use this product?, Sam and I discussed whether the next challenge is to ascertain the degree of improvement required to get people to ‘hire’ (prescribe/take) the product once it is launched. We believe that the answer to this lies in two parts:

1. When developing profiles of what to aim for, internal workshops work well to assess the improvement required vs. the products that will be available when the product is launched, as the improvement needs to be set against the future landscape. To fuel these workshops, desk research, KOL and payer research can inform what will represent a significant clinical improvement (the answer to this is often nuanced as fundamentally there needs to be a clinically significant improvement). Hence the improvement could be numerically small (e.g. 5% less patients dying from something) where the stakes are high or there are no other solutions, or much larger (20%+) to stand out in a crowd. We recommend against asking physicians and patients, as their expectations are often unrealistic – potentially looking for at least a 50% gain on efficacy endpoints or relief of symptoms.
2. When assessing a specific product profile, however, we would recommend interviewing a sample of relevant physicians to see the degree that they believe that the product meets the unmet needs in the space. It is the doctors’ recognition of the solving of unmet needs (i.e. the product being the right one to ‘hire’ for the ‘job’) that will drive their interest in the product.

To bring this new approach together, along with the rise of more personalised medicine, the final piece of the puzzle is the identification and sizing of the target patient populations as used for forecasts.

To conclude, Sam and I think that we may not yet be completely done with asking the questions will you use this product? and on what percentage of patients will you use this product? But we do think that the answers to these will be a much smaller part of our calculations that include the unmet needs assessments.

This is an important and fascinating topic, and I am committed to exploring how foresight approaches can be used to innovate forward-looking research and make a positive impact on marketing within the pharma industry.

To help stimulate new thinking, I am excited to be talking in the coming weeks with six influential experts in the healthcare space.

About Lucy Ireland

Lucy has worked in the pharmaceutical market research space for 23 years, leading research from the UK, USA and Hong Kong. She is a true multi-methodologist, having led syndicated and custom research teams as well as the development of new methodologies within quantitative and secondary research.

Lucy is passionate about innovation within the healthcare market research space. She often questions why we conduct research in a certain way to explore if there is space to innovate processes, approaches and the actual questions we ask.

Lucy started her journey in market research at Isis Research (which became Synovate Health and now Ipsos health). She then learnt a lot about what doctors talk about online at medeConnect (part of Doctors.net.uk), before joining Hall & Partners in 2013.