A New Take on Side Effects: The Personal Network Analytics Lens

Imagine this: your brand team has a promising new asset. Early results suggest it will be effective and superior to current therapies. Unfortunately, it will face competition. Worse, the competition is a low-cost generic. Now what? Is there a way the insights team can help?

A favorable drug side effect profile improves adherence, reduces the risks that cause additional healthcare costs, and provides patients with a better quality of life during treatment, all things we care about. It is also the basis for positioning the drug as superior to achieve premium pricing, especially in highly competitive categories or when brands face generic competition.

Unfortunately, side effect warnings focus on the impact on human physiology, noting only consequences like headache, nausea, depression, or syncope. Those warnings are important and necessary to understand the risk-benefit of prescribing the drug. However, they are not sufficient to understand what matters to patients or to succeed in the rough and tumble world of market access. In some cases, Personal Network Analytics might help.

Benzodiazepine Side Effects Case Study 

Half of older adults have problems sleeping. Despite known risks and clinical guidelines recommending against it for people over age 65, 13% are prescribed benzodiazepines. Unfortunately, the drug can leave people groggy the following day and cause falls. Industry studies capture those side effects. Personal Network Analytics adds to the story.

Janet (not her real name) participated in our longitudinal study to explore how to optimize network ecosystem support to help seniors age independently in their homes. At age 88, after weeks of sleep problems, her physician prescribed an inexpensive, generic benzodiazepine. When it left her groggy and unable to function for all but two hours the next day, he suggested taking it earlier in the evening. That moved the “two good hours” to earlier the following day. She still lacked time after caring for herself and her home for things she loved.

Personal Network-Informed Analytics

The first mind map shows the 145 people Janet connects with, organized according to the six networks supporting her intention to age in her home. It includes people like family and friends she sees often and those like her attorney or tax accountant she sees only episodically. The second mind map is identical, except that color-coded in red are the seventy connections she could no longer maintain due to the drug’s side effects.

New Qual and Quant Data 

Before taking the drug, Janet lived independently in her home, had a vibrant social life, and volunteered locally. She was also an exceptionally low user of healthcare, with only semi-annual physician visits to refill prescriptions for mild hypertension. Drug side effects changed that, forcing her to discontinue:

• Eight volunteer activities, including working a 12-hour shift once weekly to run a Soup Kitchen, library volunteering, and coaching high-risk teen girls.
• Three enrichment activities, including book clubs and concert groups.
• Three physical fitness activities, including gardening and workouts.
• Driving neighbors to medical center visits in a distant city.
• Hosting dinner parties, visiting friends in other states, and attending social engagements.

For the first time, she:

• Needed help from adult children and neighbors.
• Became a high utilizer of health care and, in two months, had four physician visits and two hospitalizations.
• Became lonely, depressed, and nearly abandoned her plans to age in place.

Eventually, a pharmacist recommended a branded drug as an alternative. She was willing to try it, but her physician rudely refused to prescribe it, in an encounter that caused her to leave that practice.

In addition to the quality-of-life consequences for Janet, her family, and her neighbors, there were  economic consequences:

• Janet incurred co-pay costs for hospital and physician care.
• Family caregivers lost wages and incurred caregiving costs.
• Community organizations lost her volunteer support.
• Neighbors incurred costs for paid transportation services she provided for free.
• Medicare incurred additional hospitalization and physician costs.

Now better educated about the risks and side effects, and with great resolve, she weaned herself off the benzodiazepine and found other – though suboptimal – ways to deal with sleepless nights. Had she not, for lack of a $450/month brand – an out-of-pocket cost she would have gladly paid had her physician prescribed it – she nearly incurred $8,000/month in assisted living costs.

New Insights 

This case shows how viewing the patient experience through the lens of their personal networks adds to our understanding of their journey and the ripple effects on those close to them.

It is also an opportunity to highlight the under-the-radar economic realities of the growing market of older people. Seniors have long been known to be a political force. Less known is that they are also an economic force in ways public and private payers care about. As workers, they contribute $8.3 trillion to the US economy annually. As retirees, their volunteering and unpaid caregiving contribute an additional $758B.

Their ability to age independently is critical. Unlike previous generations, they are more likely to require paid caregiving services because family support is less available:

• Families are smaller today, and women are employed, so there are fewer people to help.
• Families are geographically separated; 40% of US adults live an average of seven hundred miles away, especially if they were good in STEM subjects in high school. This impacts some industries – including healthcare – harder than others.
• 14M seniors have no family left and are aging solo; 22M Boomers never had kids and may join them.

When seniors need care, the economic impact is consequential:

• Half of US employees provide senior care. When they do, 70% struggle at work, adjust by working fewer hours, and turn down promotions. Those who leave the workforce incur costs and losses of $325K, placing their retirement security at risk.
• Employers incur costs and losses; caregivers cost 8% more for healthcare and incur $44 billion in lost absenteeism, presenteeism, and turnover productivity. This is especially burdensome for small businesses or when caregiving employees hold mission-critical positions.
• Governments incur additional costs for healthcare, meals, transportation, and other support needs.

New Opportunities for Biopharmaceuticals 

Personal Network Analytics offers market researchers an opportunity to describe side effects more comprehensively, capturing meaningful insights companies can use to enhance commercialization by: 

• Identifying new data points for clinical trials to improve the value proposition.
• Developing added content for Medical Affairs engagements with KoLs, with the potential to refine clinical guidelines.
• Sharing new insights with prescribers to change prescribing patterns.
• Creating more favorable competitive positioning to defend price and secure wider market access.
• Enhancing patient and caregiver support.
• Arming advocates with new messages for policy and market access advocacy.