When it comes to drug-delivery devices, the majority of patients are aware of their options and are willing to pay more for newer technology and user-friendly features.

These were among the findings of a recent study conducted by Cambridge Consultants, in conjunction with MassMEDIC, to determine the patient-related drivers for drug-delivery combination products.

As part of the quantitative research project, diabetes patients were recently surveyed about their experiences and priorities in selecting drug-delivery devices— two or more regulated components that include drug delivery devices such as prefilled syringes, insulin injector pens, metered dose inhalers, or transdermal patches, drug-eluting stents, or catheters with antimicrobial coatings.

Healthcare providers were also interviewed about the role of drug-delivery devices in treatment decisions and in patient medication compliance.

Patient research findings
The patient surveys were conducted with more than 240 diabetes patients, all of whom use a combination product (such as a vial and syringe, pre-filled syringe, injection pen or insulin pump) for administration of their medication. This research showed that patients are aware of their options, are driven to a certain extent by lifestyle factors such as discretion, portability and feature sets, and there is some willingness to pay more to get the features and convenience that they think are important. For example, patients taking a medication that comes in a pre-filled syringe may opt to switch to an injection pen or an auto-injector. And in the case of Saizen, a human growth hormone, many people selected this medication primarily because the delivery device was well designed and easy to use.

When patients were asked if they were ever given a choice of devices to use when they were prescribed their medication, 75% said 'yes'. And when we asked those patients that said they were given a choice how they selected their drug delivery device, predictably, the largest percentage said that they just take their doctors' recommendations. At a close second, however, a substantial number of patients said that they do their own research and even try out different devices before making a selection.

Patients were also polled about whether or not they have ever asked their doctors if they could change the drug-delivery device that they were using, and over a third indicated that they had. The primary reasons people cited for these requests were lifestyle factors such as discretion or portability of the device, as well as devices with better features and technology.

When asked, most people will say that they want newer technology and better features, but there is typically skepticism about people's willingness to pay extra for those things—particularly around medical devices. To address this discrepancy, we asked patients: "If a device was available that was easier to use than your current device, but it cost slightly more (~$5) than your current device, how likely would you be to pay more out-of-pocket for the easier device?" And even with the increased out-of-pocket cost, over three-quarters of patients indicated that they would be either 'somewhat' or 'very' likely to change devices.

These overall findings indicate that patients are aware of their options; are driven to a certain extent by lifestyle factors such as discretion, portability and feature sets; and there is some willingness to pay slightly more to get the features and convenience that they think are important.

Healthcare providers (HCPs) findings
As part of this same survey we also conducted interviews with physicians and nurse educators who either prescribe these types of devices or train patients to use combination products. These professionals came from several specialties including Pediatrics, Orthopedics, Internal Medicine, Gastroenterology, and Diabetes Education. The feedback received from healthcare providers provided further validation of the idea that there is a patient-driven component to the selection and success with drug-delivery devices.

All of the healthcare providers questioned stated that they believe that the usability of the delivery device impacts patient compliance with the medication therapy. They indicated that efficacy of the medication is a primary concern in making treatment decisions; but that they may not prescribe a medication if they don’t believe that the patient can be successful with the dosing requirements. One diabetes educator expressed the idea of "matching" the drug to the patient and that in doing so, "[the delivery device] is a piece of the puzzle - a piece that you can’t ignore."

Findings challenge traditional industry conceptions
This research underscores the fact that the least effective treatment is one that is not taken. And the efficacy of a particular drug therapy is determined by a combination of drug efficacy and compliance with the dosing regimen. The World Health Organization model describes five dimensions that affect medication adherence, including:

1. Social & Economic factors
2. Condition-Related factors
3. Therapy-Related factors
4. Health Care Team factors
5. Patient-Related factors

A well-designed drug-delivery device has the potential to positively impact the latter three of these five dimensions. Designing a delivery device to be simple and easy to use can increase the patient’s confidence in their ability to follow the treatment regimen (Therapy-Related). Ensuring that device requirements for force and manual manipulation are set appropriately can help accommodate any physical limitations patients may have, such as visual or dexterity impairment (Patient-Related Factors). And providing appropriately designed and targeted instructions and support material can help compensate for the capacity, or lack thereof, of the healthcare system to thoroughly educate patients and provide consistent follow-up (Health Care Team).

While medication compliance is certainly complex, an appropriately designed drug delivery can go a long way towards maximizing patient compliance. Compliance, in turn, is a critical component to the overall efficacy of the treatment itself, and ultimately to improved health outcomes. With the changes in the healthcare landscape, ensuring improved health outcomes is becoming increasingly critical to the financial success of companies providing the treatment therapies.