Value and how to achieve it must be broadcast through various media, a Swiss-based outcomes researcher tells HOC editor David Woods in this issue, because data that's not published is worth very little. Mary Gabb picks up this issue of visibility and clarity, explaining how to present health economics to non-economists. The take-home message: understand your audience. Clare Gurton weighs in with her personal experience of how to get the audience on your side. And Robert Hand offers some thoughts on how to gain favourable positioning for a drug. Here, he comes full circle with our Swiss researcher, finding, as he does, that the best way to communicate value is to know your customers – to find out their issues and their language. Finally, we quote from the New York Times obituary of iconic economist John Kenneth Galbraith, who died in April at age 97 and who was known for “his ability to make complicated, dry issues understandable.” We round out the issue with our “Watch Your Language” feature. And, as always, we welcome your comments and suggestions.

"One of the greatest pieces of economic wisdom is to know what you do not know."
John Kenneth Galbraith (1908–2006) – Economist

How to prove value as well as efficacy

A pharmaceutical executive working in the field of health outcomes tells HOC editor David Woods how he deals with this issue.

The best way to communicate value in a product using economics is to know your customers: find out their issues and their language. Look closely at what the product has to offer. Ask: who do I show it to, and in what format? Approaches to clinicians and to payers will be different. Value means different things to different people.

For instance, when you're dealing with marketers it's mainly about saving money; with clinicians it's more about health benefits, survival, quality of life. But you have to stay up to date with several markets so that you understand them fully – and be flexible enough to help meet local needs while building on assumptions that are universally accepted. Not only that, but the hard part is to keep a strategic vision all the time – to anticipate market needs two or three years ahead. “You can't afford to wake up and find that you've missed out on some new requirements for economic modelling. In fact, you wear two hats – technology expert and strategist.”

Asked about the state of value analysis for, say, absenteeism and productivity issues in the workplace, the reply was that again this depends on the customer; but in general at this stage it's a “nice to have” concept. Beyond that, there's an intergenerational issue looming: an increasing population of elderly means weighing value towards unmet solutions to chronic disease.

In the final analysis, though, value and how to achieve it must be broadcast through various media. “As a researcher in a field that's still relatively new, I recognize that there's lots to do. I publish abstracts on registry data and on new ways of analyzing data. You have to have the confidence that your recipients are getting the 'real McCoy', and because of the evolving models of economic analysis, you need to get the word out. Data that aren't published are worth very little.”

By Mary Gabb

When speaking to non-economists, do you end up feeling that you've made a difficult science completely unintelligible? It doesn't have to be that way. Kevin Frick, PhD, Associate Professor of Health Policy and Management at the Health Services Research and Development Center, Johns Hopkins Bloomberg School of Public Health, has been collaborating with and speaking to non-economist audiences for almost ten years. His take-home message – understand your audience.

First understand, then be understood

Dr. Frick learned that lesson the hard way. “I had been working with colleagues in the School of Nursing for six years before I really took the time to read some of their background material,” he says. When he did so, he realised that the concepts they think about resemble what he uses in building an argument for studying quality-adjusted life-years. “The economic paradigm is not outside the realm of what they're thinking about. It's just a more structured way of doing it.”

Dr. Frick notes that learning about your audience takes a certain level of investment, but it pays off with audiences saying, “That makes so much sense.” He has lectured to a wide range of clinicians, both academically and as a consultant. He is frequently called upon to give lectures on economics and a wide variety of clinical topics, and he has some suggestions for effective presentation:

• Stay consistent
  Dr. Frick says, rather than providing economic information on a “need-to-know” basis (to avoid overwhelming the audience with details), it's best to stay consistent in the level of discourse. “You have to understand whether the audience wants the 30,000-foot level, the 5,000-foot level, or the microscopic level. I try to make sure that everything I present stays at one level.”
• Use a decision tree
  Most people understand basic economic decision making, and using a simple decision tree can help to explain health economics principles. For example, the user can either do A or B, and each choice has two possible outcomes. “Even a novice can understand a decision tree and that what we're really looking at is the risk differences for what's going to happen, depending on the choice.” Once they understand the decision tree, they can understand the concepts of assumptions and risk calculations in an economic analysis.
• Keep it real
  It helps to remind audiences not only what health economics is, but also what it isn't. Health economic analyses are only as good as the efficacy/effectiveness studies upon which they are built. Discussing health economics with a non-economist can produce a better outcome for both parties. “It forces you to think about the core elements of what you do.”
• Break the rules!
  George Orwell's sixth rule for effective writing is, “Break any of these rules sooner than say anything outright barbarous”. This also holds true for presenting health economic analyses. Health economists, particularly those in pharmaceutical companies or schools of public health or medicine, must learn to adapt their communication to each audience. Reaching out to engage your audience may mean breaking some rules (for example, speaking in more detail – the microscopic level – to explain a certain point).

Dr. Frick believes that the most receptive audiences are not categorised by a particular therapeutic area or medical discipline, but are those who have a clear policy issue with which they are struggling; they are able to use the research findings in a real world problem.

"Never express yourself more clearly than you are able to think."
Niels Bohr (1885–1962) – Danish physicist

Getting drugs accepted: who succeeds and why

By Robert Hand

Health economics data play an increasingly important role in getting pharmaceuticals accepted for the drug formularies established by health insurance plans and regulatory authorities. A drug manufacturer needs to know how to use health economics data to gain acceptance for its drugs. One way is to gather case studies to show which drugs have succeeded, which have not, and why.

According to Jonothan Tierce, of ValueMedics Research, LLC, it is not merely a case of a drug being accepted for reimbursement. Rather, it involves getting the drug positioned favourably in relation to its competitors.

An effective way of gaining specific information about a competitive drug is by telephone interviews with decision makers. Interviews will be unlikely to elicit specific details of a competitor's contract, but they may reveal, for example, that the manufacturer's drug has an unfavourable price compared with the competition, or provide useful ancillary information from which the formulary status of other drugs in the class can be inferred. Anecdotal reports from field representatives can also be sources of useful information.

Tierce offers a few rules for gaining favourable positioning:

• Consider the market. In a crowded market, competitive pricing will be essential. Health economics information showing the benefits of the new product against anything other than other branded competitors will not be influential. If the drug is differentiated from its competitors, by all means show the economic benefits it provides.
• Provide appropriate tools (cost-effectiveness, but also contracting and budget impact models) for demonstrating a drug's value to the plan. In an uncrowded market, health economics data can also be used to show that a drug is worthy of Tier 2. Tools should consider the value of performance-based contracting, since most plans are used to this type of arrangement.
• The best strategies look beyond the plan to the whole market. They create product demand among both patients and physicians. As an example, so-called unbranded campaigns can create awareness of a particular disease state. This can then link patients and physicians to a branded campaign that provides information and promotional coupons for the manufacturer's drug. If health plans see that demand for the drug is expanding the drug's market share, they will want to work with the manufacturer to develop mutually beneficial contracts.

Effective communication

Try to be yourself

by Clare Gurton

Giving talks and presentations is never easy but sometimes things go very much more smoothly after a mistake.

This may sound strange but by letting your audience see that you are human, you can effectively burst the bubble and get the audience on your side. I remember an occasion when satellite links were fairly new and I was relying on one to talk with a colleague in the US in front of an international audience at an important symposium. Guess what? The link broke down halfway through. At first it seemed awful but actually everybody laughed, relaxed, and then listened to me.

This was my first lesson in learning to be myself. Whilst I am not advocating making a deliberate mistake, it is worthwhile trying to be yourself, even a little vulnerable, when giving a presentation. You may not realise that the audience is on your side and knows how daunting it can feel – remember the audience is human too.

"A successful person is one who can lay a firm foundation with the bricks that others throw at him or her."
David Brinkley, US television newscaster 1920–2003

Look out for news and views from the ISPOR International conference, plus finding those journals with a positive interest in health economics.

John Kenneth Galbraith, who died in April, was admired, envied and sometimes scorned for his eloquence and wit and his ability to make complicated, dry issues understandable to any educated reader. He enjoyed his international reputation as a slayer of sacred cows and a maverick among economists [and] whose pronouncements became known as ‘classic Galbraithian heresies.' – taken from New York Times, 30 April 2006