Patient Channel ROI Evaluation

IMS Health Consulting

December 2009

Agenda
Objective Research Methodology Methodology Assumptions Study Results Conclusions

Objective
To assess the impact of the Patient Channel program on Brand X prescribing behavior of participating physicians

Patient Channel for Brand X

Incremental Brand X NRx, Physician Penetration and ROI

Research Methodology
Impact of the Patient Channel program for Brand X was assessed using IMS Consultings Promotion EvaluationSM methodology
Paired comparison analysis to measure changes in Brand X new prescription writing behavior of a Test group relative to a similar group of Control physicians
Utilizes physician-level new prescription data* that is raw, or not projected, which removes any potential bias that might be introduced by projection

*Data source: IMS Healths prescriber prescription database

Methodology Assumptions
Test and Control group physicians are assumed to have similar levels of exposure to promotional activity for the duration of the study time period
Cannot control for disproportionate changes in promotional levels in the postprogram exposure time period

Managed care influences are also assumed to be similar between the Test and Control physicians
Cannot control for disproportionate changes in patient flow or patient health care plans at any time of the study time period

Control Group Selection

34,345 potential Test physicians were matched to the IMS Health prescriber universe to identify potential Control physicians based on the following criteria:

Brand X script writing behavior/volume in the pre-test period;

MD specialty;

MD geography; and
Overall writing decile 32,189 Test physicians were successfully matched to a Control physician

Quality Control Procedures

A key quality control procedure was utilized to ensure that sporadic reporters do not bias the results
Active Writers a physician must generate at least one prescription during the most current three months to be included in the analysis

6 Month Analysis

Brand X NRx Comparison

During the six month post period, Test physicians prescribed 1.3% more Brand X NRx compared to Control physicians. This change in prescribing behavior is statistically significant (cl=95.17%).
40000 35000 30000 25000 20000 15000 10000

Brand X NRx

5000
0
Pre-6 Per-5 Pre-4 Pre-3 Pre-2 Pre-1 Test Post-1 Post-2 Post-3 Post-4 Post-5 Post-6

Test

Control

Note: cl = Confidence level; if cl >= 90% the program impact is significant, cl=80-90% is directional. Analysis conducted : ANCOVA.

6 Month Analysis

Brand X Physician Penetration Comparison

Physician penetration increased by 2.0 percentage points among the Test group and by 1.6 points among the Control. The resulting differential in penetration of +0.4 points between the two groups is not statistically significant (cl=51.47%).
57.0%

2.0 point increase

56.4%

56.5% 56.0% 55.5% 55.0% 54.5% 54.0% 53.5% 53.0% 54.4%

1.6 point increase

56.0%

% Physician Penetration

54.4%

Test Group Pre-Test

Control Group Post-Test

Note: Physician Penetration is defined as the ratio of MDs writing Brand X / MDs in program. Analysis conducted : Z-test

ROI Analysis Methodology

Step I
Plus TRx retail price)

6 Month Analysis

Calculate Average Product TRx (average retail price for a prescription) = TRx sales/ 6 month study period (for Brand X is $154.79 (source: IMS NPA Calculate Revenue Associated with Test Physicians = Projected Product TRx x Average Product Price 1,151,276 x $154.79 = $178,202,558 Calculate Revenue Associated with Control Physicians = Projected Product TRx for Control Physicians* x Average Product Retail cost 1,136,501 x $154.79 = $175,915,580 Incremental Revenue due to the program = Revenue Associated with Test Physicians Revenue Associated with Control Physicians $178,202,558 - $175,915,580 = $2,286,978 Return on Investment = Incremental Revenue from program/ Cost of the program $2,286,978/$487,749 = 5:1 or $1,799,229

Step II

Step III

Step IV

Step V

Note: Projected Product TRx for Control physicians calculated using Index of Adjusted Means (1.01) from ANCOVA, which means Test physicians wrote 1.3% more Brand X NRx than Control physicians during a 6 month post-test period. Program costs reflect costs associated with only the measured hospitals during the 6 mo post-test period.

12 Month Analysis

Brand X NRx Comparison

During the twelve month post period, Test physicians prescribed 2.1% more Brand X NRx compared to Control physicians. This change in prescribing behavior is statistically significant (cl=99.94%).
45000 40000 35000 30000
Brand X NRx

25000 20000 15000 10000 5000 0

Pre-6 Pre-5 Pre-4 Pre-3 Pre-2 Pre-1 Test Post-1 Post-2 Post-3 Post-4 Post-5 Post-6 Post-7 Post-8 Post-9 Post- Post- Post10 11 12

Test

Control

Note: cl = Confidence level; if cl >= 90% the program impact is significant, cl=80-90% is directional. Analysis conducted : ANCOVA.

12 Month Analysis

Brand X Physician Penetration Comparison

Physician penetration increased by 8.6 percentage points among the Test group and by 7.8 points among the Control. The resulting differential in penetration of +0.8 points between the two groups is directional (cl=88.33%).
64.0% 62.0% 60.0% 58.0% 56.0% 54.4% 54.0% 52.0% 50.0% Test Group Pre-Test Control Group Post-Test 54.4%

8.6 point increase

63.0%

7.8 point increase

62.2%

Note: Physician Penetration is defined as the ratio of MDs writing Brand X / MDs in program. Analysis conducted : Z-test

% Physician Penetration

ROI Analysis Methodology

Step I
NPA Plus TRx retail price)

12 Month Analysis

Calculate Average Product TRx (average retail price for a prescription) = TRx sales/ 12 month study period (for Brand X is $158.15 (source: IMS Calculate Revenue Associated with Test Physicians = Projected Product TRx x Average Product Price 2,371,358 x $158.15 = $375,028,845 Calculate Revenue Associated with Control Physicians = Projected Product TRx for Control Physicians* x Average Product Retail cost 2,322,584 x $158.15 = $367,315,266 Incremental Revenue due to the program = Revenue Associated with Test Physicians Revenue Associated with Control Physicians $375,028,845 - $367,315,266 = $7,713,579 Return on Investment = Incremental Revenue from program/ Cost of the program $7,713,579/$988,905 = 8:1 or $6,724,674

Step II

Step III

Step IV

Step V

Note: Projected Product TRx for Control physicians calculated using Index of Adjusted Means (1.02) from ANCOVA, which means Test physicians wrote 2.1% more Brand X NRx than Control physicians during a 12 month post-test period. Program costs reflect costs associated with only the measured hospitals during the 12 mo post-test period.

18 Month Analysis

Brand X NRx Comparison

During the eighteen month post period, Test physicians prescribed 3.2% more Brand X NRx compared to Control physicians. This change in prescribing behavior is statistically significant (cl=100.0%).

40000 35000 30000 25000

Brand X NRx

20000 15000 10000 5000 0

Test Brand X

Control Brand X

Note: cl = Confidence level; if cl >= 90% the program impact is significant, cl=80-90% is directional. Analysis conducted : ANCOVA.

18 Month Analysis

Brand X Physician Penetration Comparison

Physician penetration increased by 12.4 percentage points among the Test group and by 10.9 points among the Control. The resulting differential in penetration of +1.5 points between the two groups is statistically significant (cl=99.47%).

80.0%

12.4 point increase

66.9% 54.4%

10.9 point increase

65.4% 54.4%

% Physician Penetration

70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0%

Test Group Pre-Test

Control Group Post-Test

Note: Physician Penetration is defined as the ratio of MDs writing Brand X / MDs in program. Analysis conducted : Z-test

ROI Analysis Methodology 18 Month Post Test

Step I
NPA Plus TRx retail price)

18 Month Analysis

Calculate Average Product TRx (average retail price for a prescription) = TRx sales/ 18 month study period (for Product is $157.64 (source: IMS Calculate Revenue Associated with Test Physicians = Projected Product TRx x Average Product Price 3,442,456 x $157.64 = $542,678,747 Calculate Revenue Associated with Control Physicians = Projected Product TRx for Control Physicians* x Average Product Retail cost 3,335,713 x $157.64 = $525,851,471 Incremental Revenue due to the program = Revenue Associated with Test Physicians Revenue Associated with Control Physicians $542,678,747 - $525,851,471 = 16,872,276 Return on Investment = Incremental Revenue from program/ Cost of the program $16,872,276/$1,432,035 = 12:1 or $15,440,241

Step II

Step III

Step IV

Step V

Note: Projected Product TRx for Control physicians calculated using Index of Adjusted Means (1.03) from ANCOVA, which means Test physicians wrote 3.2% more Brand X NRx than Control physicians during an 18 month post-test period. Program costs reflect costs associated with only the measured hospitals during the 18 mo post-test period.

30 Month Analysis

Brand X NRx Comparison

During the 30 month post period, Test physicians prescribed 4.8% more Brand X NRx compared to Control physicians. This change in prescribing behavior is statistically significant (cl=100.0%).

40000 35000 30000 25000

Brand X NRx

20000 15000 10000 5000 0

Test Brand X

Control Brand X

Note: cl = Confidence level; if cl >= 90% the program impact is significant, cl=80-90% is directional. Analysis conducted : ANCOVA.

30 Month Analysis

Brand X Physician Penetration Comparison

Physician penetration increased by 18.3 percentage points among the Test group and by 15.6 points among the Control. The resulting differential in penetration of +2.7 points between the two groups is statistically significant (cl=100.0%).

80.0%

18.3 point increase

71.7%

15.6 point increase

68.9%

% Physician Penetration

70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Test Group Pre-Test 53.4% 53.4%

Control Group Post-Test

Note: Physician Penetration is defined as the ratio of MDs writing Brand X / MDs in program. Analysis conducted : Z-test

ROI Analysis Methodology 30 month post test

Step I
NPA Plus TRx retail price)

30 Month Analysis

Calculate Average Product TRx (average retail price for a prescription) = TRx sales/ 30 month study period (for Product is $159.48 (source: IMS Calculate Revenue Associated with Test Physicians = Projected Product TRx x Average Product Price 4,887,002 x $159.48 = $779,396,672 Calculate Revenue Associated with Control Physicians = Projected Product TRx for Control Physicians* x Average Product Retail cost 4,663,170 x $159.48 = $743,699,139 Incremental Revenue due to the program = Revenue Associated with Test Physicians Revenue Associated with Control Physicians $779,396,672 - $743,699,139 = $35,697,533 Return on Investment = Incremental Revenue from program/ Cost of the program $35,697,533/$1,988,927 = 18:1 or $33,708,606

Step II

Step III

Step IV

Step V

Note: Projected Product TRx for Control physicians calculated using Index of Adjusted Means (1.05) from ANCOVA, which means Test physicians wrote 4.8% more Product NRx than Control physicians during a 30 month post-test period. Program costs reflect costs associated with only the measured hospitals during the 30 mo post-test period

Conclusions
This retrospective 5-year look compared prescription writing behavior by doctors affiliated with Patient Channel hospitals to a control group of physicians in the IMS database that have been matched by the Brands script writing in the pre period, overall script writing volume, geography and physician specialty. The study assessed incremental NRx, physician penetration (# of docs prescribing) and program ROI at several points over a 5-year period. IMS Consultings Promotion EvaluationSM methodology was employed. Unless otherwise noted, all results are statistically significant.

Metric/ Time Period

NRx +1.3%
+2.1%

Physician Penetration Directionally higher Directionally higher

ROI 5:1
8:1

6 month
12 month

18 month
30 month

+3.2%
+4.8%

+1.5 pts.
+2.7 pts.

12:1
18:1