Welcome to the December issue

By Kevin Frick (kevin.frick@rxcomms.com)

It is ironic that we should have to answer the question: “what is the value of outcomes research?” when outcomes research is a key component of establishing the value of healthcare. Despite the seemingly obvious answer, i.e. “we could not possibly establish the value of healthcare without outcomes research”, there is reason to pause. The meaning of the value of healthcare may not be entirely obvious, single works of outcomes research do not always provide all the information necessary to establish value, and the use of value assessment in real world policy-making is not always apparent.

What is the meaning of “value”? Critically, the value of healthcare depends on the perspective of the decision-maker who is assessing the value. For the government, the value may be in limiting expenditures for a programme such as Medicare or a National Health Service. Government decision-makers may also be directly concerned about the health of the population. For an employer, the value of healthcare may be in limiting workplace absenteeism. For an individual in the population, the value may be a combination of saving money, providing for a family, greater functionality, and enjoying life in general.

Outcomes research can document all these meanings of value, but a single study will rarely establish savings in medical care claims, changes in absenteeism, and changes in other aspects of quality of life. However, taken as a whole, multiple studies of outcomes provide information that can be critical for formulating policy. For decision makers to use the information in the process of making policy, those performing outcomes research must demonstrate not only the importance of their own work but the importance of the set of work into which their work fits. A coherent literature review that integrates a study into the extant literature is useful for achieving this objective.

Thus, outcomes research has value when each study, viewed in combination with other works, is useful in establishing the value of healthcare from multiple perspectives so that more informed policy can be made for the optimal allocation of healthcare resources.

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By Robert Hand (robert.hand@rxcomms.com)

As a health economist and outcomes researcher, you may work primarily within a single country. Naturally, you know the economic, regulatory, and management issues of that country. However, with globalisation, you need increasingly to be aware of the corresponding conditions around the world.

Why? Individual countries or cooperative groups of countries can differ markedly in how they regulate pharmaceutical development and marketing, control the pricing of pharmaceuticals and other aspects of healthcare, and pay for healthcare. All these factors significantly affect health economics.

Most pharmaceutical and healthcare device companies already have to adapt their operations to do business across borders. Often, their research involves studies conducted in two or more countries. Of course, once a new product or service is developed and approved, the manufacturer has to contend with marketing it in different countries.

As a researcher, how can you keep abreast of the varying international environments? One place to start is with “Pharmacoconomic Guidelines Around the World,” at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) website (www.ispor.org/PEguidelines/index.asp).

Derived from an article by Tony YH Tam and Marilyn Dix Smith in ISPOR Connections (volume 10, number 4, August 2004), the webpage presents guidelines that can be used as standards for preparing studies for inclusion in an application for reimbursement, guides for designing and conducting studies, or templates for evaluating economic study report. The current set includes 28 guidelines from 23 countries, grouped as Eastern Europe, Western Europe, Northern Europe, Southern Europe, Northern America, Eastern Asia, and Oceania. Guidelines are presented as hyperlinks, full text (as copyright permission allows), or publication reference.

Among the guidelines are 21 pharmacoeconomic guidelines, six submission guidelines, and one guideline for journal publication.

The webpage also includes a comparative table of 32 key features of the guidelines. These include the type, title, and year of the document, main policy objectives, standard reporting formats included, target audience, and the various analytical factors used.

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A new way for pharmaceutical companies and prescribers to interact?

By David Woods (david.woods@rxcomms.com)

Call them Sermoans, Sermophiles, or just plain members, the 32,000 physicians enrolled in Sermo could be changing the way that pharmaceutical companies interact with healthcare professionals.

Certainly Pfizer thinks so. Having laid off 20% of its US and European sales teams last year, it recently linked up with Sermo – an internet-based social networking site for doctors which was founded in September 2006. Pfizer will work with Sermo to establish how drugmakers can communicate with physicians online and provide drug and disease information to them, and Sermo’s members will have a forum for seeking diagnostic advice from their peers.

Sermo’s founder and CEO, Dr Daniel Palestrant, said in an interview with HOC: “The concept is a simple one. I talked to my colleagues about clinical events and then read about them in the mainstream press weeks later.” Palestrant, a surgeon turned entrepreneur, wondered how these kinds of discussions could be captured and made available to all physicians.

Sermo faced three challenges, he said: what would motivate physicians to share the observations and conversations they made with colleagues? What would the business model be? How could credibility and confidentiality be ensured? Initially, the concept was supported by financial services companies, and government and research entities, and Dr. Palestrant was reluctant at first to involve the pharmaceutical industry. But then Sermo’s physician members themselves asked to be connected with that industry because much relevant and useful therapeutic data emanates from it. “And so,” he says, “we looked for a company that would work on our community’s terms.”

At a time when the pharmaceutical industry is finding it increasingly difficult to gain access to physicians, not just because of regulations that preclude providing them with meals and gifts... but because physicians themselves are more and more pressed for time, the timing may be right for new initiatives. So-called detailing, says Palestrant, “can be effective; but it's expensive and contentious.” Doctors’ relationships with pharma have worsened in recent times, he believes, but each needs the other, and engagement is preferable to a standoff. Sermo, he says, provides the technology to change the way they talk to each other.

The company expects that other pharmaceutical companies will soon follow Pfizer’s lead, and has plans to expand its service into Europe.

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By David Woods (david.woods@rxcomms.com)

A pair of economists, Charles Jones of the University of California at Berkeley and Robert Hall of Stanford University, predict that the share of income devoted to healthcare in the US will almost double to 30% by 2050.

While some of that increase has to do with an aging population and ever more sophisticated technology, much of it has to do with waste, duplication, defensive medicine brought on by possible litigation... and by general inefficiency and antiquated ways of connecting and communicating.

One much-touted solution to all this is for healthcare to embrace technology in much the same way as have the insurance and airline industries. In fact, that quintessential techie, Bill Gates, noted in the Wall Street Journal recently that the central issue is the fragmented nature of the way health information is created and collected. Few industries, he said, are as information dependent and data rich as healthcare: every visit to a physician, every test and measurement and procedure generates more information; yet every clinic, hospital department, and doctor’s office has its own systems for storing that information and most of them don't talk to one another.

Gates went on to say that his company, Microsoft, envisions a comprehensive internet-based system that enables healthcare providers to automatically deliver personal health data to each patient in the form they can understand and use.
But it won't be easy. Healthcare is an immensely fragmented enterprise with often competing and sometimes counterproductive fiefdoms. Nonetheless, Microsoft's software powers more than 90% of all personal computers... something that Bill Gates sees as having the potential to attract huge audiences for health-related information, advertising, and services.

And Google is not far behind in this desire to “wire” healthcare, and put the patient at the centre of healthcare delivery, creating a more collaborative partnership rather than a top-down, ex-cathedra approach. In fact, Google Health's welcome page reads: “At Google, we feel patients should be in charge of their health information, and they should be able to grant their healthcare providers, family members, or whomever they choose, access to this information. Google Health was developed to meet this need.”

At a time when all the candidates for the presidency of the United States are putting forth differing views of how America's broken healthcare system can be fixed, wiring it is surely something they can all agree upon. Even the man about to leave the presidency has jumped on this particular issue. In his 2006 State of the Union address, George W. Bush called upon the healthcare community to “make wider use of electronic records and other health information technology.”
It’s an idea whose time has definitely come.

“I think the best thing is always to put a good face upon a disagreeable state of affairs.”
Benjamin Disraeli (1804–1881) British statesman and author.

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By Mary Gabb (mary.gabb@rxcomms.com)

A frequently overlooked professional skill – especially among scientists – is public speaking, yet the inability to effectively communicate your work can place significant roadblocks in your career.

Here are some ways to remove those blocks:

1. Be prepared. It is your responsibility as a speaker to ensure that all of the equipment works (ie, laptop, laser pointer, lights, PowerPoint program and any animations or video clips within the presentation). You should also view the room layout before your presentation, including walking around the room to ensure all attendees will be able to see and hear you.
2. Practice. One of the most egregious errors public speakers make is going over the time limit. Practice your presentation and be sure it can be done within the allotted time, allowing for questions when appropriate.
3. Introduce yourself. An effective way to gain control of your presentation is to write your own introduction. Supply the person introducing you with the information you wish to be said about you.
4. Record yourself. Most of us don’t realise our speaking idiosyncrasies – the unconscious ums, ahs, and okays, and other nervous ticks or “space fillers” we use. Record yourself giving a presentation to hear which one(s) you use. Only when you recognise them can you begin to eliminate them. Videorecording can show you the physical tics.
5. Watch others. Make notes when you watch other presenters – even news reporters on television – about your likes and dislikes of their presentation skills.
6. Take a public speaking course. There are numerous public speaking courses available. One of the most well known is Toastmasters International (www.toastmasters.org), which uses a step-by-step programme to help the speaker address such skills as use of visual aids, vocal variety, and organising a presentation. Each speaker is given constructive criticism in a supportive environment. Toastmasters is available in 90 countries.

* Mary Gabb was a past President of her local Toastmaster’s club. Toastmasters is a nonprofit organisation.

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Healthcare Outcomes Communicator is designed to help you explain and enhance your role and value as healthcare economists and outcomes researchers. But we need input from you – the professionals working "in the trenches". So we encourage you to give us your feedback about how we're doing – to communicate with us so that we can better communicate with you.

Yours sincerely
David Woods and the Rx Communications team

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