Topics Continued: The value of medicines and the way of medical checkups, etc. as considered by ordinary consumers Comparison based on attributes such as presence or absence

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Yosuke Nakano, Senior Researcher, National Institute of Biomedical Innovation Policy
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, Yokohama City University School of Medicine

1. Introduction

In the previous issue of the ISSP News ⁽ No.621 ^), the authors reported the results of a web-based questionnaire survey on the various values of medicines (in terms other than efficacy, safety, and treatment cost) that ordinary consumers consider important, as well as their attitudes toward future consultations and prescriptions, triggered by the spread of the new coronavirus epidemic. The survey was a preliminary report and did not include a comparative analysis of the respondents' attributes.

Therefore, in this report, we conducted a comparative analysis based on attribute information (mainly disease status, gender, and age) by adding additional patient data (n=328) obtained from a patient panel to the general consumer data in order to investigate how the response results differ depending on the respondent's attributes.

Survey Methodology

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

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. attribute information

In order to make comparisons based on the presence or absence of disease, we defined patients with disease as those who responded that they had a disease and visited the hospital regularly at least once a month during the year (April 2019 to March 2020) before the declaration of a state of emergency due to the spread of novel coronavirus infection (n = 520), (Patient Panel Group ^{2) (} n=328) and together they were defined as "patients (n=848)".

Table 1 shows the percentages by age group for each healthy adult/patient. In patients, the proportion of males in their 50s-60s is particularly higher than in the others. Next, the disease breakdown of patients is shown in Figure 1. The most common disease was hypertension, and lifestyle-related diseases (hypertension, diabetes, and dyslipidemia) accounted for about 1/3 of the total.

4. survey results

4-1. values of drugs other than efficacy, safety, and cost of treatment

The respondents were asked about the importance of various values of medicines (other than efficacy, safety, and cost of treatment). (The questions and options are listed in the Supplementary Materials at the end of this document.) In order to determine the impact of the presence or absence of specific diseases (disease recall) on the responses, the questions were divided into twogroups: those without disease recall and thosewith disease recall.

No disease recall

The results of responses without disease recall (maximum of 3 responses) are shown in Figure 2. The items framed in the figure are the top three factors in the overall (n=2,483) response results.

Comparing healthy adults and patients, many items showed similar or slightly higher percentages for patients, but no items showed a large discrepancy. The largest difference was in the "N/A" category, which showed a higher percentage (+6%) for healthy adults.

On the other hand, when compared by gender, women showed higher percentages for more items, and the difference was also larger than in the healthy adult/patient comparison (the largest difference was for "reduced uncertainty (effects and side effects can be predicted by prior testing)" (+11%).

Furthermore, a comparison by age group confirmed that many items increased in proportion to age, with the largest difference being the difference between those in their 20s and 60s (+11%) in "reduction of medical burden.

With disease recall

Figure 3 shows the results of the comparison between healthy adults and patients when specific diseases were presented. As specific diseases, descriptions of three types of diseases (hypertension, rheumatoid arthritis, and cancer), which are assumed to have different effects on patients' quality of life and mental health, were presented as supplementary information at the end of the text.

Similar to the results for "no disease recall," with the exception of "not applicable," no items showed a large discrepancy in the comparison of healthy adults and patients for any disease, although many items showed a slightly higher percentage for patients.

Effects of employment status on "labor productivity" Fear of unknown infectious diseases

With regard to labor productivity (i.e., avoiding missing or quitting work due to medication), a comparative analysis was conducted between employed and non-employed persons (students, housewives/househusbands, and unemployed) in order to compare the differences in responses by employment status (Figure 4).

As a result, the percentage was higher among the employed (the largest difference was +7% for "cancer"), but a certain number of responses were also obtained among the non-employed.

4-2. prioritized value perspective (other than efficacy, safety, and cost of treatment)

The respondents were asked whose perspective (other than efficacy, safety, and cost) they prioritize when choosing a drug (questions and options are provided at the end of the paper as supplementary materials). The results showed that the top priority was given to oneself, one's family, healthcare professionals, and society, in that order, with "healthcare professionals' or society's viewpoint" ranked first by approximately one in five respondents (Figure 5). Therefore, we focused on this No. 1 result and compared the attributes.

Comparing the results of the No. 1 ranking, the percentage of respondents who selected "healthcare professionals' or society's viewpoint" as a priority was higher among healthy adults, males, and those in their 20s-40s (Fig. 6).

4-3. Views on future consultations and prescriptions in the new lifestyle

The following section presents the results of the comparison of the respondents' attitudes toward future consultations and prescriptions. As in the previous section, comparative analysis was conducted by disease status, gender, and age, with a focus on results that showed significant or characteristic differences.

Fear of unknown infectious diseases

As a prerequisite for understanding the respondents' attitudes toward future consultations and prescriptions, we asked them about their fear of unknown infectious diseases at the time of the survey, based on their experience with the spread of the new coronavirus epidemic.

As a result, women were more likely than men and other generations were more likely than men in their 20s to feel "still very afraid" by about 10% (Figure 7). Comparison results between healthy adults and patients were comparable.

Fear of unknown infectious diseases

Patients were more likely than healthy adults to want "only traditional face-to-face care" (+14%). When the sample was narrowed down to those who have had online medical care in ^{the past3)}, many of them desired online medical care in the future, but approximately 30% of them desired "only conventional face-to-face care" (Figure 8). Furthermore, by age, the number of respondents who preferred face-to-face treatment increased in proportion to their age. On the other hand, the percentage of respondents who preferred online treatment (central & only) did not differ among generations, at around 20%.

Future prescriptions

Regarding future prescriptions, there were no significant differences in responses between healthy adults and patients, gender, and age (Figure 9). There were also no differences between healthy adults and patients or between generations in online prescribing and home delivery of medications, which are often discussed in the wake of the Corona disaster.

5. summary

A comparative analysis was conducted on how the results differ depending on the respondents' attributes (mainly disease status, gender, and age) in the questionnaire regarding the various values of medicines that are important to the general public and their attitudes toward future visits to the doctor and prescriptions. The results are discussed.

First, in terms of the value of medicines (in terms other than efficacy, safety, and treatment cost) that they consider important, we had assumed that there would likely be differences in the items that they consider important depending on whether they have a disease or not, but a comparison between healthy adults and patients showed no significant divergence in the responses to each item. In other words, it was confirmed that, as far as the value elements surveyed were concerned, the views on the value of important medicines did not differ significantly depending on whether or not the respondents themselves already had a disease. Rather, gender and age were more likely to influence the differences than disease status.

One limitation of this survey is that, as shown in Figure 1, the breakdown of diseases among respondents was a mixture of various diseases, with lifestyle-related diseases (hypertension, diabetes, and dyslipidemia) accounting for about 1/3 of the total, and the results are not comparative with a specific patient group. If the results were compared to a specific patient population, attitudes toward the value of drugs might be more different.

It was also confirmed that a certain number of non-workers also consider values related to "labor productivity" to be important, and that whether or not they are currently employed does not have a significant effect. It can be inferred that the non-workers also consider the importance of "labor productivity" in consideration of its impact on their families and other factors. Furthermore, it is thought that the number of people who consider this value important may increase if the improvement in individual labor productivity can be appropriately demonstrated as well as the effect and degree of impact on the economic loss of society as a whole.

On the other hand, when looking at the intention of future visit/prescribing patterns, the results showed that patients who actually visit the hospital on a regular basis place more importance on face-to-face consultations. Although it had been speculated that a greater percentage of younger patients would give priority to online medical care (central & only), the results confirmed that there is a certain need for it regardless of age. It is possible that the patients with the Corona Disaster had no choice but to receive treatment online even if they did not want to, or that the environment for online medical care was not sufficiently developed.

In addition, the need for new services such as online prescriptions and mailed or home delivery of medicines did not differ significantly among healthy adults/patients or age groups, suggesting that all demographic groups have the same needs for new services.

Finally, in order for the pharmaceutical industry to realize sustainable innovation, it is essential that the various values of pharmaceuticals created as a result of innovation are properly evaluated. We hope that the results of this survey will contribute to the discussion and consideration of this issue, and we hope that the discussion on the evaluation of the various values of pharmaceuticals will progress.

Supplementary data

1) Question and answer options regarding the "value of medicines that are important to you" (Figure 10)

Question

In addition to efficacy (effectiveness), safety (side effects, etc.), and treatment cost (cost of drugs and treatment of future illnesses), what other items do you think are important in terms of the value of new drugs?

Source: Prepared by the author.

2) Recall sentences presented in each disease recall (Figure 11) ⁴⁾

Source: Prepared by the author.

(iii) Question and response options regarding "Priority value perspective" (Figure 12)

Question

When selecting a drug, in addition to the perspectives of drug efficacy (effectiveness), frequency and nature of side effects (safety), and treatment cost, please order the following perspectives in the order you think they are important

Source: Prepared by the author.

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