Table of Contents

Consumer-Targeted Internet Investment Online strategies to improve patient care and product positioning Executive Summary 8 Empowering the online consumer 8 Improving the physician-patient relationship 9 Reaching care-givers online 10 Online disease management 10

Chapter 1 Empowering the online consumer 14

Summary 14 Introduction: turning attention from physicians to consumers 15 Report overview 17 Methodology 19 Characterizing the consumer base 19 Perceived personal health consciousness 20 Favored sources of health information 21 Online sources of health information 22 Drawing the health conscious to online information 23 Who looks for health information online? 25 Regional variation: US versus Europe 25 Generational variation: growing up online 26 Gender variation: women on the web 28 Online health information needs 28

Chapter 2 Improving the physician-patient

relationship 32 Summary 32 Introduction 33 Methodology 34 The evolving physician-patient relationship 34 Consumer perceptions of the impact of the Internet 34 Desired role of the Internet 36 Demand by therapy area 38 Discussion of specific medication 38 Printable health related materials 39 Desire to discuss information found online 40 The ideal: the empowered consumer 41 The future physician-patient relationship 43 The value of improved communication 43 Patients as a marketing channel to physicians 44 The ideal online resource for patients 44 Consumer use of mobile technology for health related purposes 47

Chapter 3 Reaching care-givers online 50

Summary 50 Introduction 50 Definitions 51 Methodology 52 Overview of the proxy care market 52 Current market size 52 Care-givers’ health information needs 54 Preferred information sources 55 Barriers to greater Internet use 57 Reaching care-givers of children and parents 59 Proxy care for children 59 Where child care-givers look for health information 60 What child care-givers want from an online resource 61 Proxy care for parents 61 Where parent care-givers look for health information 61 What parent care-givers want from an online resource 62 Current trends in proxy care websites 63 Future trends in the online proxy care market 65 The ideal online proxy care resource 66

Chapter 4 Online disease management 70

Summary 70 Introduction 71 Definitions 72 Methodology 72 Benefits of pharmaceutical company investment in disease management 73 Improved therapy persistence 73 Reaching European patients 74 Improved outcomes 74 Case study: Health Hero 76 Good publicity 78 Barriers to pharmaceutical company investment in disease management 78 Costs 78 Liability 79 The market for disease management programs 81 Physicians support the disease management concept 81 Types of products and patients to target 83 Case study: MSWatch.com 85 The future of online disease management 87

Chapter 5 Appendix 92

References 92 Index 93

List of Figures

Figure 1.1: Larger sales forces are no more efficient at revenue generation than smaller sales forces 16 Figure 1.2: Consumers typically consider themselves highly health conscious even though they do not actively seek health information 20 Figure 1.3: 57% of consumers seeking health information have consulted Internet sources 22 Figure 1.4: Pharmaceutical company sites are just as popular as government and medical institution websites in the US and UK 23 Figure 1.5: Pharmaceutical companies must increase awareness of the availability, quality and security of online information 24 Figure 1.6: On average, 32% of Europeans and 53% of Americans use the Internet to search for health information 26 Figure 1.7: Use of the Internet as a health information source decreases with age 27 Figure 1.7: Women use the Internet to search for health information for themselves and their families 29 Figure 2.1: Impact of the Internet on the physician-patient relationship 35 Figure 2.2: Desired role of the Internet in the physician-patient relationship 37 Figure 2.3: Consumer interest in specific therapeutic categories 39 Figure 2.4: Presentation of printed online materials to physicians, segmented by therapy area 40 Figure 2.5: Desire to discuss online information with physicians, segmented by therapy area 41 Figure 2.6: Pharmaceutical companies want to make consumers more proactive in the treatment decision making process 42 Figure 2.7: Targeting physician-patient interaction 45 Figure 2.8: Use of mobile technology to access healthcare information 48 Figure 3.1: In addition to themselves, a sizeable proportion of consumers look for health information for other people 53 Figure 3.2: Health topics of interest to care-givers in the US and Europe 55 Figure 3.3: Care-givers’ preferred information sources 56 Figure 3.4: Concern about privacy and security on the Internet is a prominent reason care-givers in the US do not look online for health related information 58 Figure 3.5: A significant proportion of child care-givers look for health information about their children 59 Figure 3.6: Child care-givers’ demand for health information decreases as their children age 60 Figure 3.7: Online support for care-givers of parents with Alzheimer’s disease: Janssen’s Reminyl.com 63 Figure 3.8: An ideal website for care-givers should drive regular use by offering frequently updated features and interactive tools 67 Figure 4.1: The Health Hero technology platform 76 Figure 4.2: Online disease management programs can significantly improve outcomes in chronically ill patients 77 Figure 4.3: Pharmaceutical company sponsored disease management programs support rather than replace other aspects of care 80 Figure 4.4: More patients could benefit from disease management than currently participate in programs 82 Figure 4.5: Most physicians are not put off by pharmaceutical company sponsorship of disease management programs 83 Figure 4.6: Perceived value of features of disease management applications 85 Figure 4.7: MSWatch – Teva’s online disease management resource for multiple sclerosis patients and their carers 86 Figure 4.8: Providing patients with tools to improve outcomes can assist pharmaceutical companies in gaining/maintaining formulary preference 89

List of Tables

Table 1.1: Men use the Internet more frequently than women for all purposes except looking for health information 28 Table 2.1: Impact of the Internet on the physician-patient relationship 36 Table 2.2: Desired role of the Internet in the physician-patient relationship 37 Table 3.1: Beneficiaries of health information searches 53 Table 3.2: Health topics of interest to care-givers in the US and Europe 55 Table 4.1: Therapeutic suitability for targeting with disease management applications