The shape and consequences of risk evaluation are measured in new Quintiles survey

As part of its ongoing New Health Report, Quintiles (Durham, NC) focused this year on the landscape of risk in decision-making among biopharma execs, payers, patients and investors; both US and UK sets of these groups were surveyed. Generally speaking, US patients are more risk-averse than their UK counterparts, and believe that they are well-informed about drug risks more than UK patients do. Quintiles speculates that this might be an effect of DTC advertising (broadly available in the US; less so in the UK), wherein risk and side-effect information is mandated.

Quintiles finds some "disconnected thinking" in US patients' opinions of the availability of drugs with attendant risks; by margins ranging from 69% to 72%, US patients think it takes too long for FDA to approve drugs, and that patients should be able to choose potentially risky therapies more freely; but at the same time, 50% believe that the approval process is too quick. Also, 51% of US patients said that they had turned down a medication recommended by a physician because of concerns over safety or side effects, and a nearly equal proportion had stopped taking a medication (without consulting with the prescriber) over the same concerns. By comparison, only about a quarter of UK patients had turned down a prescription, and only a third had stopped. Again, Quintiles speculates that the effects of warnings in DTC advertising might be a factor. "This underscores the industry's imperative to better communicate the values and risks of new medications in terms that are meaningful to patients," Quintiles concludes.

Risk-based questions were also put to a group of US payers, as well as executives in the National Health Service in the UK (essentially the single payer there). "Risk" in this context means the financial risk of spending money on a therapy that might not work; both sets of payers would like to see pharma companies take on more risk; and substantial fractions of both groups say that they are willing themselves to take on more risk.

One aspect of risk-sharing is to collaborate during the drug-development process, and Quintiles developed a "wheel" of the drug development process, showing how engaged payers are (or would like to be) during preclinical-to-post-approval. While the engagement rises at each phase of development for both US and UK payers, overall the UK payers are more engaged, and express a higher degree of desire for more engagement. "The lack of involvement by payers in drug development indicates that the biopharmaceutical industry does not interact effectively with its customers--who are increasingly the payers, more so than physicians and patients--about the products that it should be making," concludes Quintiles.

The survey also covers topics like shared-risk contracts, investors' appetite for risk, and methods for analyzing risks and outcomes. It is available at Quintiles' website (www.quintiles.com).