How do Initial Signals of Quality Influence the Diffusion of New Medical Products? The Case of New Cancer Drug Treatments

Barriers and facilitators to the uptake of new medicines into clinical practice: a systematic review

“…Most of the studies ( n = 62) used quantitative methods [ 21 – 49 , 51 – 65 , 68 – 79 , 81 – 86 ]; three were qualitative [ 50 , 67 , 80 ], and one was mixed-methods [ 66 ]. The predominant source of data collection was secondary data ( n = 46) from various databases and registries [ 22 – 25 , 27 , 29 – 34 , 36 , 40 – 44 , 46 , 48 , 51 – 64 , 66 , 70 – 72 , 74 , 78 , 79 , 81 – 85 , 87 ]. Other studies ( n = 17) used surveys [ 26 , 44 , 47 , 67 , 68 , 73 ], interviews [ 21 , 26 , 37 , 50 , 57 , 66 , 67 , 76 , 80 ], patients’ medical records [ 28 , 45 ], prescriptions from community pharmacies [ 75 ], observations [ 35 ], or a focus group [ 80 ] to collect primary data.…”

“… Funding: national funding body COI: none Chitagunta et al (2009), USA [ 32 ] To study the role of learning in the diffusion of three Cox-2 Inhibitors before withdrawal of rofecoxib Quantitative Prescription and advertising expenditure databases, published articles Primary and secondary care celecoxib, rofecoxib, valdecoxib 6577 patients and 17,329 prescriptions Advertising, news and academic articles; Socio-economic status of patient; Patient’s demographic characteristics; Patient’s health insurance plan type; Patient’s satisfaction with existing treatment. Funding: not reported COI: not reported Chressanthis et al (2012), USA [ 33 ] To examine the effect of access limits to pharmaceutical representatives on new medicines prescribing by physicians Quantitative IMS Health databases Primary and secondary care sitagliptin 65,131 physicians Organisation restrictions to pharmaceutical representative access; Speciality and age of prescriber; Size and geographical location of organisation Funding: AstraZeneca COI: two authors were employees of AstraZeneca Conti et al (2012), USA [ 34 ] To examines how evidence of the incremental effectiveness of novel chemotherapy medicines impacts on the adoption by physicians Quantitative Chemotherapy order system database Secondary care Seven oral chemotherapy medicines 4,344,711 patients, 122 medical oncology practices in 35 the USA states Severity of the underlying disease; Clinical trials and media reports concurrent with market launch date; Medicine effectiveness. Funding: national funding body COI: not reported DeVore et al (2018), USA [ 35 ] To identified patient, provider, and practice characteristics associated with sacubitril/valsartan use Quantitative Observations Primary and secondary care sacubitril/valsartan 4216 patients, 121 sites across the USA Patient’s clinical and demographic characteristics; Socio-economic status of patient; Patient’s health insurance plan type; Speciality of prescriber; Size of organisation; Staff composition at the organisation.…”

“…Prescribers highlighted that patients’ clinical characteristics and comorbidities influenced new medicines use [ 50 ]. Some prescribers reported prescribing new medicines for patients with more severe disease [ 34 , 35 , 46 , 63 , 82 ] or polypharmacy [ 22 , 25 , 43 ]; five studies were high-quality [ 34 , 35 , 43 , 46 , 82 ]. Other low to high quality studies reported new medicines use in patients with fewer comorbidities, or less severe conditions [ 22 , 28 , 51 , 72 – 74 , 78 , 79 ], and no polypharmacy or concomitant use of medicines increasing the risk of side effects [ 28 , 72 , 73 , 79 ].…”

“…Some prescribers stated relative effectiveness of a new medicine influenced their prescribing decisions in medium-quality studies [ 50 , 68 , 69 , 80 , 86 ]. A high-quality study, focusing on novel chemotherapies, suggested that perceived better quality rather than incremental effectiveness influenced new medicine use [ 34 ].…”

Value of Information Methods to Prioritize Research

“…However, recent work by Conti, Bernstein and Meltzer (2012) suggests that diffusion patterns of novel molecularbased therapeutics may not follow standard diffusion paths implicit in the standard assumptions of CEA, and may differ substantially from that of new therapies in other clinical areas. Individualized care: VOI methods need to be expanded to understand how costs may be better internalized as to capitalize on the value of individualized care, utilizing an expected value of individualized care (EVIC) measure.…”