Jukti Kumar Kalita, PhD Business Analytics and Insights Pfizer Presented at:

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1 Hospital to Retail Spillover Analysis and Its Impact on Commercial Decision Making Jukti Kumar Kalita, PhD Business Analytics and Insights Pfizer Presented at: 1

2 Disclaimer The information provided and opinions expressed by the presenter and set forth in the following slides are those of the individual presenter and should not be attributed to Pfizer Inc., any of its affiliates, or any of its or their directors, officers, or employees, nor any other organization with which the presenter may be affiliated. Unless specifically stated otherwise, examples and views provided herein, including strategies, goals, targets, and indicators, are for illustrative purposes only and should not be regarded as representative of Pfizer or its portfolio. Content in this presentation is the intellectual property of the individual presenter and subject to protection under the copyright laws of the United States of America and other countries.

3 Life Sciences Commercial Data Insights Presentation Objective In this presentation, we discuss how multiple large data sources and complex analytics can be used to derive actionable insights to help commercial groups in large pharmaceutical companies Datasets Analytics Decision Support Activity Prescriptions HCP to Hospital Mapping Zip Code to Hospital Mapping Other data Trend, Correlation, Regression Field Force Sizing Samples to Patient HCP and Patient Communication 3

4 Life Sciences Commercial Data Insights (continued) Presentation Objective Our focus is on better understanding the resource allocation needs for therapeutic areas where treatment often starts in hospitals but is maintained outside in retail HCP offices. Disease Diagnosis and Initial Treatment vs. Hospital MD s Office 4

5 Life Sciences Commercial Data Insights (continued) Presentation Objective Resource allocation needs may be related to the number of field representatives who provide information on disease states, clinical studies and medicines to health care providers. Reps also hold speaker programs where physicians, often from academic institutions, have discussions with their peers on best ways to treat patients. Resource allocation needs may also be related to drug samples that are given to HCPs who in turn provide these to patients who can try out the best medicine for long-term treatment, patient assistance programs or patient education brochures. 5

6 Agenda Introduction to Hospital to Retail Spillover Physician Spillover Patient Spillover Importance of Measurement of Hospital to Retail Spillover Use of Multiple Large Data Sources to Synthesize Insights Data Sources to Measure Physician Spillover Data Sources to Measure Patient Spillover Other Data Sources Results and Implication 6

7 Agenda Introduction to Hospital to Retail Spillover Physician Spillover Patient Spillover Importance of Measurement of Hospital to Retail Spillover Use of Multiple Large Data Sources to Synthesize Insights Data Sources to Measure Physician Spillover Data Sources to Measure Patient Spillover Other Data Sources Results and Implication 7

8 Hospital to retail spillover occurs in two main ways Intro to Spillover Hospital and Its Neighborhood Dynamics of Hospital Spillover Direction of Spillover Sales within Hospitals Rx s from HCPs who work in hospitals and also own practices or have colleagues who work in hospitals + Patients from far away may decide to get treated in a hospital because of its reputation and continue post treatment with HCPs in own localities ) Physician Spillover Patient Spillover 8

9 Spillover area of a hospital could vary depending on its reputation overall or within a therapeutic area University Hospital in a Large NE City No. Zip Codes Serviced: 1,000+ Total Cases: ~20,000 Total Days of Care: 100,000+ Intro to Spillover Source: Publicly Available Database 9

10 Spillover area of a hospital could vary depending on its reputation overall or within a therapeutic area University Hospital in the South No. Zip Codes Serviced: ~100 Total Cases: ~2,500 Total Days of Care: ~15,000 Intro to Spillover Source: Publicly Available Database 10

11 Hospital to retail spillover emerges from the fact that a therapy initiated in a hospital tends to be maintained by the community physician Spillover varies by therapeutic area Intro to Spillover Initial diagnosis and treatment in hospital Continuation of therapy by community physician Change in therapy after admission Lifestyle related therapies: Mostly initiated in HCP offices Chronic conditions and co-morbidities: Mainly initiated in HCP offices, but a patient could get admitted into a hospital for other comorbidities and diagnosed with diabetes; maintenance through ARBs, OADs and insulins Acute, event driven conditions or therapies: Most starts in hospitals when patient gets admitted, with maintenance through beta-blockers and statins by office based HCPs Pfizer Confidential 11 11

12 Patients who get started on a drug in the hospital (or retail) setting tend to stay on it for a length of time, as captured by adherence and persistency metrics 90% Persistency Rates for Brands Intro to Spillover % Persistency 70% 50% 30% A C B D 10% Month from patient s start Product Patient life time RX value A 20 B 15 C 10 D 5 Numbers presented here are for illustrative purpose only Pfizer Confidential 12 12

13 Agenda Introduction to Hospital to Retail Spillover Physician Spillover Patient Spillover Importance of Measurement of Hospital to Retail Spillover Use of Multiple Large Data Sources to Synthesize Insights Data Sources to Measure Physician Spillover Data Sources to Measure Patient Spillover Other Data Sources Results and Implication 13

14 An understanding of hospital to retail spillover may have an impact on the resource allocation decision Importance of Spillover Estimation of the magnitude of hospital-retail spillover is important to commercial teams in making resource allocation decisions Retail Field Force Size No Spillover Consideration 500 Spillover Consideration 400 Hospital Field Force Size Numbers presented here are for illustrative purpose only 14

15 An understanding of the hospital to retail spillover may have an impact on hospital segmentation Importance of Spillover Hospital segmentation may need to be updated if hospital to retail spillover is incorporated into decision making. For example, hospitals with larger footprint may need more reps to hold discussions with HCPs on disease states and available treatment. No Spillover Consideration Hospital Segment Resources Spillover Consideration Hospital Segment Resources Changes to segmentation and annual call activity Numbers presented here are for illustrative purpose only 15

16 An understanding of the hospital to retail spillover may have an impact on patient assistance and affordability programs Impact on the Pricing Decision Importance of Spillover No Spillover Consideration Spillover Consideration Hospital that gets discounted pricing Hospital that gets regular pricing Numbers presented here are for illustrative purpose only 16

17 Agenda Introduction to Hospital to Retail Spillover Physician Spillover Patient Spillover Importance of Measurement of Hospital to Retail Spillover Use of Multiple Large Data Sources to Synthesize Insights Data Sources to Measure Physician Spillover Data Sources to Measure Patient Spillover Other Data Sources Results and Implication 17

18 Multiple large data sets are used to derive insights through complex analytics Data Sources Drug Usage and Purchase 1 Rx Data at HCP Level Drug Purchase Data at Hospital Level 2 HCP Spillover (HCP to Hospital Linking Data) 3 4 Affiliation Data (External) Affiliation Data (Internal) Patient Spillover (Hospital to Zip Code Linking Data) 5 Health Atlas Data (Publicly Available) Additional Data to Optimize Resources 6 Internal Activity and Resources Data Response analysis Optimization modeling Usage by Indication 7 Survey Audits or Anonymized Patient Level Data with ICD-9 Codes 18

19 Databases that link HCPs to hospitals are used to assess physician component of the spillover Databases that Link HCPs to Hospitals Data Sources Corporate Parent Corporation / Integrated Systems Organization to organization relationship Provider Facilities Healthcare Facility Healthcare Professionals Prescription Activity MD, NP, RN, PA. TRx Organization to healthcare provider relationship Source: Internal and External Data Sources Pfizer Confidential 19 19

20 Databases that link HCPs to hospitals can be maintained internally at a manufacturer or be available from external sources Data Sources Fields in a Typical HCP to Institution Mapping Database HCP ID Facility ID Facility Name Facility Address Facility City Facility State Facility Zip Facility Type Parent Company ID Parent Company Name Parent Company Address Parent Company State Parent Company Zip Parent Company Type Source: Internal and External Data Sources Examples and views herein are for illustrative purposes and should not be regarded as representative of Pfizer or its Pfizer portfolio. Confidential 20 20

21 Databases that link treatment zip codes to hospitals are used to measure patient component of the spillover Data Sources Typically used to study variations in distribution and usage of medical resources in national, regional, and local markets Used by policymakers and health care analysts to study health care system Forms the foundation for many efforts to improve health and health systems Examples of publicly available research that uses Health Atlas Data Health Care Spending, Quality and Outcomes (2009) Prices Don t Drive Regional Medical Spending Variations (2010) The Elusive Connection Between Health Care Spending and Quality (2010) Our Parents, Ourselves: Health care for an Aging population (2016) The Revolving Door: A Report on US Healthcare Admissions (2014) Source: Publicly Available Data Sources Pfizer Confidential 21 21

22 Databases that link patient treatment zip codes to hospitals are used to measure patient component of the spillover Data Sources Fields in a Database that Links Patients to Hospitals Hospital ID Count Of Zip Codes of Residence Total Days of Care Total Cases A ,000 10,000 B ,000 3,000 C ,000 5,000 D 70 7,000 1,000 E 70 2,000 1,000 F 100 7,000 1,000 G ,000 3,000 H ,000 7,000 I ,000 2,000 J 25 1, K ,000 4,000 L M ,000 3,000 N 80 5,000 1,000 Source: Publicly Available Data Sources 22

23 Example Research: Regional Variation in Use of Beta Blockers After Heart Attack Use of beta blockers within first six months following hospitalization for heart attack ( ) Data Sources Source: The Dartmouth Atlas of Medicare Prescription Drug Use, The Dartmouth Institute for Health Policy and Clinical Practice, 2013; Accessed on 10/1/2016 Pfizer Confidential 23 23

24 Anonymized patient level data used to calculate factors for multiple indications for a drug Anonymized patient level databases typically run into hundreds of millions of rows Such databases generally have several components Data Sources Diagnosis Data Includes ICD-9 (or ICD-10) codes that can be used to identify disease conditions like diabetes, high blood pressure, arrhythmia, etc. Prescription Data Includes names of drugs, both generic and branded When filled Units, form and strength HCP id Zip code of patient Eligibility Information Indicates if the anonymized patient level data has been captured continuously Provider Data HCP ID and specialty, etc. Payer Data Name and address Source: External Data Sources Examples and views herein are for illustrative purposes and should not be regarded as representative of Pfizer or its Pfizer portfolio. Confidential 24 24

25 Agenda Introduction to Hospital to Retail Spillover Physician Spillover Patient Spillover Importance of Measurement of Hospital to Retail Spillover Use of Multiple Large Data Sources to Synthesize Insights Data Sources to Measure Physician Spillover Data Sources to Measure Patient Spillover Other Data Sources Results and Implication 25

26 Hospital to retail spillover could vary considerably from one therapeutic area to the next Quantifying Hospital Influence on a Therapeutic Area Results and Implications Hospital sales (Non-retail) Direct Sales Low spillover for lifestyle related therapies Medium spillover for chronic conditions or co-morbidities High spillover for acute, event driven conditions and therapies Sales to HCPs who work in hospitals, but are affiliated to hospitals (Retail) Physician Spillover Nonspillover Patient Spillover Sales due to influence on patients from distant localities 26

27 Field force sizing decision may be revisited with the hospital level spillover sales data Broad Range of Sales Drivers Results and Implications Driver 1 Sales Data Data at level of individual hospitals Hospital + Retail Spillover months of data Mixed regression model (PROC MIXED in SAS) Driver 4 27

28 Optimization may demonstrate a need to change field force size Results and Implications Optimization using response curves and economic principle of marginal revenue equals marginal cost at the optimal point 28

29 Results and Implications Field force resources may need to be increased to promote to hospitals for therapeutic areas with large spillover Therapeutic Area with Significant Spillover Retail FF Size No Spillover Consideration 500 Spillover Consideration 400 Hospital FF Size Numbers presented here are for illustrative purpose only 29

30 Data for four US hospitals show that those with larger foot print may more resources to optimally provide support to HCPs and their patients need 30

31 Summary Hospital to retail spillover varies by therapeutic area. For chronic disease states where therapy frequently begins at hospitals, but is maintained outside by community HCPs, spillover could be significant. Both physician and patient spillover components are important. Resource allocation decisions may be impacted by spillover. For example, hospitals with a large spillover may need more reps to provide optimal support to HCPs and their patients. 31

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