Patient Empowerment: Consequences for Pharmaceutical Marketing and for the Patient–Physician Relationship - Innovation and Marketing in the Pharmaceutical Industry - page 438

effective (relative improvement in adherence of 1.11-1.14). Individual case
management was the most costly ($90-130 per patient for a 6-month intervention)
but the most effective (relative improvement in adherence of 1.23-4.65; Chapman
et al. 2010 ). As therapy adherence is increasingly seen as a key research topic in
health marketing (Stremersch and Van Dyck 2009 ), the literature on patient therapy
adherence keeps growing (Bowman et al. 2004 ; Dellande et al. 2004 ; Kahn and
Luce 2003 ; Lee et al. 2007 ; Luce and Kahn 1999 ; Neslin et al. 2009 ; Wosinska
2005 ). To maximize the return on investment of adherence programs, marketers
need to use all available research and information to carefully ponder all direct and
indirect benefits and risks and the intervention costs for designing and implement-
ing adherence programs.

14.5 Is Big Pharma Embracing Patient Empowerment

as a Key Strategic Goal?

Having reviewed the ongoing trend towards patient empowerment and the conse-
quences of this paradigm shift in medical decision-making for the patient-physician
relationship, therapy launch, and therapy promotion, my next goal is to analyze
whether pharmaceutical companies are already focusing on the patient empower-
ment trend as a key strategic goal. To answer this question, I collected the annual
reports of the 20 largest pharmaceutical companies for the 6 years between 2005
and 2010 and content analyzed them to measure the degree of each firm's strategic
orientation towards patient empowerment. Content analysis of firm documents such
as shareholder letters and annual reports is recognized by scholars as a good strat-
egy to understand firms' strategic orientations (Noble et al. 2002 ).
I selected the top 20 firms by global sales of prescription drugs using
Pharmaceutical Executive's latest ranking (Cacciotti and Clinton 2011 ), which
should have yielded a total of 120 annual reports. However, there were six reports
that I could not find in a format suitable for content analysis (Novartis 2010, Sanofi-
Aventis 2005, Merck 2010, Abbott 2006 and Boehringer Ingelheim 2008 and 2009),
which yielded a sample of 114 annual reports. These 20 companies account for
$483.8 billion in sales of prescription drugs, which is 81.53 % of the total revenues
of the top 50 global pharmaceutical firms (Cacciotti and Clinton 2011 ). Table 14.2
depicts the 2010 global sales of prescription drugs for each of these 20 companies
(or Rx, in USD billions) and the location of their headquarters and firm expenditures
on R&D in the same year.
To content analyze these reports, I converted each of the reports to plain text.
Afterwards, I counted the number of times words contained in a set of keywords
related to patient empowerment were mentioned in the annual report (see Appendix
for the keyword list). 17 The chosen keywords include terms that directly indicate

17 I would like to thank Viorel Milea, at the Econometric Institute of the Erasmus School of
Economics, for his invaluable help in the programming of the Python code I used to perform this
content analysis.