Topics What ordinary consumers think about the value of medicines and how they should receive medical examinations, etc. From a web-based questionnaire survey in the wake of the Corona disaster

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Yosuke Nakano, Senior Researcher, Pharmaceutical and Industrial Policy Research Institute
Mariko Hirozane, Researcher, Graduate School of Pharmaceutical Sciences, The University of Tokyo
Visiting Associate Professor, Graduate School of Pharmaceutical Sciences, The University of Tokyo
Associate Professor, Health and Social Medicine Unit, Faculty of Medicine, Yokohama City University
Naka Igarashi

1. Introduction

The authors have reported on the current status and issues of value evaluation and outcome measurement in clinical trials in foreign countries, referring to the various values of pharmaceutical products in the past ISPI News ^1-3.

The global spread (pandemic) of an unknown infectious disease called novel coronavirus infection is assumed to have caused a major change in people's awareness and sense of values regarding not only infectious diseases but also medical care and treatment.

Although several surveys have been conducted on the attitudes of patients and the general public toward medical care and consultations under the influence of new drug coronavirus infection, ^4)-5 it is our understanding that no survey has been conducted on attitudes toward drugs and prescriptions.

Therefore, taking this major environmental change as an opportunity, we attempted to conduct a web-based survey to understand the various values of medicines (efficacy, safety, and perspectives other than treatment cost) that are considered important by the general public, as well as their attitudes toward future consultations and prescriptions. This paper reports the results of this survey in the form of a preliminary report.

2. Survey Methodology

This Web-based survey was conducted using the following content.

The survey was conducted in late November 2020, a time when information on the "third wave of novel coronavirus" was frequently reported in the news and other media in Japan, and the general public was beginning to pay renewed attention to the spread of novel coronavirus infection.

It should be noted that this survey is not a fixed-point survey to compare before and after the impact of new coronavirus infection, and the limited age range of the target population is presented in advance as a limitation of the survey.

3. Survey Results

3-1. Value of drugs considered important other than efficacy, safety, and cost of treatment

The survey asked what value elements were important to the general public in relation to the various values of medicines (other than efficacy, safety, and cost of treatment). In order to see differences between those with and without disease recall, questions were asked separately for those without disease recall and thosewith disease recall. Figure 1 shows the questions and response options.

The value factor options used in this survey were reviewed and selected based on ISPOR's Task force ^report6), the authors' previous ^{research1)-3)}, and trends in overseas HTA ^{organizations7)}, 8 ⁾.

No disease recall

Figure 2 shows the results of responses without disease recall. Although this question was answered without setting a response limit and later narrowed down to a maximum of three, there was no significant difference in the response trends between the two groups.

First, the highest percentage was for the value related to "reduction of uncertainty" (i.e., the ability to foresee effects and side effects through prior testing). This is related to so-called "personalized medicine" or "precision medicine" (precision medicine), which has become a hot topic in recent years, and more than 50% of the respondents (without limiting the number of responses) considered it important. Next in importance were "fairness" and "reduction of medical burden. It was particularly interesting to note that "reduction of medical burden" ranked high.

With disease recall

Next, Figure 3 shows the results of responses when specific diseases were presented. For each disease, we presented descriptions of three types of diseases (hypertension, rheumatoid arthritis, and cancer) that have different effects on the patient's QOL and mental ^health9) (see the end of the text for supplementary information).

In each of the cases in which these three specific diseases were recalled, "reduced uncertainty" was the top response, similar to the case in which no disease was recalled. On the other hand, the proportion of "reduction in medical burden" was lower than in the case of no disease recall, suggesting that in the case of no disease recall, there may have been greater awareness of medicines and vaccines against infectious diseases that can cause severe illness, such as new coronavirus infection.

In addition, when compared by disease, the values that respondents considered important varied slightly for each disease, with the value of "reducing the burden of caregiving (reducing the physical, mental, and financial burden on family members who provide care and support for the sick)" being particularly high for rheumatoid arthritis and cancer.

3-2. Priority value perspectives (other than efficacy, safety, and cost of treatment)

In addition to efficacy, safety, and cost, the respondents were asked whose perspective (position) they prioritize when choosing a drug. The question text and answer choices are shown in Figure 4.

The results show that the order of priority was self, family, healthcare professionals, and society (Figure 5). This can be interpreted as the closer the distance from oneself, the higher the priority, which was to some extent the expected result. On the other hand, however, the percentage of respondents who answered that the viewpoint of medical professionals or society was important in the first and second place was approximately one in five (22%) in the first place and approximately one in three (32%) in the second place, giving the impression that the percentages were higher than the authors had expected.

3-3. Views on future visits to doctors and prescriptions in the new lifestyle

The following are the results of responses regarding the general public's attitudes toward future consultations and prescriptions.

Fear of unknown infectious diseases

As a prerequisite for ascertaining attitudes toward future consultations and prescriptions, the respondents were asked about their fear of unknown infectious diseases at the time of the survey, based on their experience with new drug coronavirus infection.

As shown in Figure 6, approximately 50% of the respondents were still afraid of unknown infectious diseases at the time of the survey. This situation is thought to have a certain influence on their attitudes toward future visits to the hospital and prescriptions.

Fear of unknown infectious diseases

Many respondents had some concerns about future hospital visits and face-to-face consultations (Figure 7, top), with "contact with other patients (50%)" and "visits to the medical institution itself (42%)" being the most common concerns, in that order.

On the other hand, more than 60% of the respondents thought that the future method of medical consultation would be mainly face-to-face (Figure 7 bottom). It was confirmed that many people still prefer the conventional style of consultation. On the other hand, about 20% of the respondents wanted to focus on online medical care. In addition, more than 50% of the respondents were positive about online medical care, including those who "want to use it partially," a result similar to that in other ^surveys5).

When only patients (those who had been visiting the hospital at least once a month before the spread of the novel coronavirus) were asked about their "experience using online medical services," only about 10% of them responded that they had used online medical services.

In other words, although the number of those with actual experience of online medical care was small under actual medical care, about 20% of the total respondents wished to receive mainly online medical care, indicating that there is a need for it to some extent.

Future prescriptions

In terms of their thoughts on future medications and prescriptions, it was confirmed that there is a certain level of need for self-administration, online prescribing and home delivery, as well as a decrease in the frequency and contact with hospital visits (Figure 8). Among these, more than 30% of respondents expressed a need for online prescriptions and home delivery of medicines, indicating that there is a certain level of expectation for improved convenience in the act of receiving medicines.

4. Summary

In light of the impact of the new coronavirus infection, we conducted a web-based survey of general consumers regarding their values and attitudes toward medicine, medical examinations, and other issues. As a result, several interesting insights were obtained.

First, it was confirmed that the general public is aware of or expects the value of "reduction of medical burden (human and physical burden)" from medicines. This value itself is something that could have been considered in the past, but if the survey was conducted before the spread of the new coronavirus infection, it is highly likely that it would not have been well recognized, and it is assumed that the new coronavirus infection has triggered a strong recognition of this value. In other words, this result was a reminder that the value of medicines is not immutable and can change with changes in times, social conditions, and other factors.

In fact, in the wake of the pandemic of the new coronavirus, some overseas HTA organizations (in the U.K. and Canada) have recognized and referred to "reduction of medical burden (human and material burden)" as a value in their guidelines and evaluation ^reports7),8 and the results of this survey are linked to this trend. The results of this survey are also linked to this trend.

Through the questions that presented three specific diseases, it was also possible to confirm that the values considered important vary depending on the disease. Although it is not easy to determine the criteria, it may be necessary to consider the value factors to be taken into account and evaluated according to the disease. For example, "reduction of caregiving burden" of family members who provide care and support for oneself is a value factor that many people consider important. However, further examination and research will be needed to properly evaluate such values.

Furthermore, many of them regarded "reduced uncertainty" as important, regardless of the disease. This can be said to mean that, at present, many ordinary consumers (patients) have concerns, etc. about the effects and side effects of drugs. Knowing or being able to know in advance has value for patients, such as bringing a sense of security and making it easier for them to decide to change their treatment if the drug is not suitable for them. The value of this "reduction in uncertainty" and its evaluation were considered to be elements that should be discussed further in the future.

Finally, it was confirmed that a certain percentage of the general public has new needs (e.g., online medical care and prescriptions, home delivery of medicines, etc.) for future medical visits and prescriptions. It is believed that the spread of infection will gradually provide new solutions and change the behavior of patients in receiving medical examinations and the way healthcare is provided. Pharmaceutical companies will be required to prepare for and respond to such changes.

Supplementary data

The following is a list of the most important values of drugs other than efficacy, safety, and cost of treatment (with disease recall), as well as the recall sentences for each ^disease9).

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