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CEO INTERVIEW: LEO goes ‘beyond the product’

This article was originally published in Scrip

Executive Summary

It is now widely acknowledged that with healthcare costs escalating and global budgets under pressure, companies cannot count on securing high prices for new medicines purely on the basis that they are innovative. Demonstrating value is critical in the new market context. Scrip's Eleanor Malone spoke to Gitte Aabo, CEO of Danish dermatology firm LEO Pharma, to learn more about her company's value proposition.

Gitte Aabo, CEO LEO Pharma (copyright LEO Pharma)

Big pharma companies tinker with them, but for LEO Pharma patient support services in various forms are a core activity, along with R&D. LEO (with annual sales of about €1.1 billion) sees both elements as vital parts of a necessarily holistic offering. CEO Gitte Aabo firmly believes that conditions like psoriasis are more than just skin conditions, and that it is particularly important to "go beyond the product" across dermatology in order to treat patients effectively.

"Skin diseases in general tend not to be regarded as serious. But for patients, aside from the physical impact, they can be associated with a significant psychological and social impact," explains Ms Aabo. She pointed out that a survey asked people suffering from psoriasis and another serious condition such as hypertension or diabetes to select which condition they would wanted cured, hypothetically. Forced to choose, more than 90% of patients elected to fix the skin condition.

"Treatments need to work in everyday life. We aim at making our treatments safe and effective (that's a given), but also core to our mission is ensuring products work for patients," says Ms Aabo. "Patients need to get information, knowledge and support, to give them insight and motivation: this is an area where pharmaceutical companies and healthcare professionals need to do much better," she observes.

The way LEO applies this philosophy to extend its remit beyond the traditional sphere of a product development and commercialization company is both a lesson for others and a study in how the future is likely to look.

anthropologists

To really get inside the skin of its patients, the firm conducts extensive interviews and has even had anthropologists live with sufferers ("people don't always think of everything in a questionnaire", points out Ms Aabo), and used its findings to design its QualityCare program as well as to develop better products.

In practice, for LEO, this means offering a range of extended support to patients, from daily text message reminders to apply treatments, through hotlines patients can call to receive advice and information from nurses, integrated care clinics and web-based information services and collaboration with patient associations. It also means developing more appropriate therapeutic products to increase the likelihood that patients will comply with their treatment regimen – adherence is a significant issue in dermatology.

Only last week this approach earned the company the award for Excellence in Provision of Patient Services (in association with Atlantis Healthcare) for its 'touch' Patient Support Program for people with psoriasis at the Pharmaceutical Market Excellence Awards (the firm also won the prize for small company of the year and a prize for launch excellence for its Dovobet gel).

Personalising treatment

"What we have learned over time is that it's not 'one size fits all'," notes Ms Aabo. "People are different and support has to be individualized." Appropriate patient support is also affected by the market in which it is offered, and LEO has rolled out a range of programs tailored to the markets in which they are offered, which range from the US through Europe to China, where it is experiencing "very high growth" since entry in 2009 and has a dedicated affiliate employing some 100 staff.

Evidence that this patient support approach works is being accumulated: Ms Aabo states that the firm has compared sales growth in Chinese hospitals where it provides the support with that in hospitals where it doesn't and seen that sales growth is 16% higher in those that do. "This is because it increases adherence," she declares.

Meanwhile, the company is conducting a clinical trial designed to establish the link: PSOTOP has enrolled several hundred psoriasis patients, with one arm receiving treatment alone and the other arm also having access to support programs. Final data are expected next year.

LEO believes that in dermatology patient convenience is more than a 'nice to have': It is at the core of effective treatment because it has a major impact on patient adherence and therefore the value to payers as well as sufferers. Illustrating her point, she says that some conventional psoriasis treatments are formulated as greasy ointments and can take an hour to dry after application. "This can mean people have to get up an hour earlier to apply their treatment." Evidently, such inconvenience plays a part in reducing patient compliance, which impacts directly on cost-effectiveness and on the sufferer's quality of life. Hence, for LEO the development of products for psoriasis like Daivobet/Dovobet/Taclonex gel (calcipotriol/betamethasone) which are absorbed more quickly, represent a boon for patients.

Improving patient compliance, and therefore treatment effectiveness and ultimately the value to payers was also a big factor in the development of Picato (ingenol mebutate) gel, which last month received European Commission approval as a treatment for actinic keratosis (skin lesions which if left untreated may lead to squamous cell carcinoma).

Whereas previously used topical treatments need to be applied for one to four months and can be associated with side-effects that reduce compliance, Picato is a once-daily, two- or three-day topical treatment. This short treatment time "has a huge impact on real life outcomes, which is good for patients and payers", and because patients are so much more likely to adhere to treatment, "patient outcomes are 100% comparable to those seen in clinical trials", points out Ms Aabo.

The company is in the process of establishing pricing for Picato gel in Europe. Since gaining approval in the US in January, 50,000 patients have been treated, which is in excess of the company's prior expectations.

LEO Pharma's approach to generating value for patients and payers has not been pain free: in October it announced a business and investment rethink that would result in the loss of 300 mainly European jobs from its workforce of around 5,000 and certain functions being outsourced.

Citing changes to European pharma markets characterized by price pressure, healthcare budget cuts and growing patient and payer power, Ms Aabo said at the time it was necessary to "rethink the way we work" to take a "more innovative and focused approach" and to go "beyond products to provide care solutions" and "support people in achieving better treatment outcomes".

Patient support solutions are clearly a big part of LEO's answer to the fact that, in Ms Aabo's words, "payers… rightfully demand added value from our industry". The company plans to throw its back into enhancing these offerings and taking them to more markets in 2013. Others, take note.

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