Biomedical Engineering Reference
In-Depth Information
when making prescription choice and explicitly modeled the conditions under
which switching reasons were reported. In their model, physicians' uncertainty
about treatment effectiveness and side effects of alternative drugs comes from two
sources: fi rst, treatment outcomes are heterogeneous across patients; and second,
even the mean effectiveness and side effects may be unknown to physicians and
patients, especially for those drugs that are new to the market. They assumed that
physicians learn from patient feedback as well as from the pharmaceutical compa-
ny's one-to-one marketing communication efforts such as the detailing, and they
allowed the informational content of detailing visits differ across the two drug attri-
butes. They estimated the model using a physician-level panel data from the ED
category for a period from August 2003 to October 2004. There were three drugs in
this category: Viagra was launched in March 1998, followed by two new drug
entries in 2003, Levitra in August and Cialis in November.
Their estimation result showed that the two new drugs, Levitra and Cialis, had
signifi cantly higher mean evaluation in effectiveness than the existing drug, Viagra.
However, Levitra had the largest variation in effectiveness, while Cialis had the
largest variation in side effects, among the three drugs. Because of the smaller het-
erogeneity in physician and patient evaluations as well as the existence of a signifi -
cant switching cost, Viagra still had a signifi cant market share even after 1 year of
the two new drug entries. These results coincided with the reality that Viagra posi-
tioned itself as the “safest” (as manifested through its smallest heterogeneity in side
effects) ED drug while Cialis was promoted on the base of its maximum “effective-
ness” among the three in their recent advertising campaign. An additional fi nding
from the “what-if” experiments shed light on the direction for the pharmaceutical
company's product improvement effort: it was critical for Levitra to increase the
consistency in treatment effectiveness and for Cialis to reduce the variability in side
effects, instead of improving the average effectiveness or side effects across patients
only. Their results also showed physicians had a large prior uncertainty regarding
the effectiveness of Levitra and side effects of Cialis. Detailing with or without meal
was more effective in reducing the uncertainty of effectiveness among physicians
compared with learning from patient feedbacks. Specifi cally, they found that just
one detailing visit was suffi cient in eliminating prior uncertainty of the mean effec-
tiveness among physicians for both new drugs. In contrast, there still existed consid-
erable amount of prior uncertainty in mean effectiveness even with feedback from
ten revisiting patients. However, detailing was less effective in reducing the uncer-
tainty of side effects. Roughly speaking, the informative role for side effects of one
detailing with or without meal was comparable to that of one patient feedback.
These results suggested that for sales representatives the provision of information
about side effects should be the priority in their “messaging” strategies during their
subsequent detailing visits. If it was diffi cult for sales representative to convey clear
message regarding side effects because of multiple side effects and lack of clear
documentation on the incidence of these during clinical trials, managers might want
to switch to other methods such as free sampling through which patient trials hence
quick patient feedbacks may be induced to reduce the prior uncertainty in side
effects.
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