Cholesterol lowering medication preference in EU5 countries

Daiichi Sankyo approached Ipsos to survey HCPs and adult populations of EU5 countries with high blood cholesterol at high or very high risk of cardiovascular disease and currently taking prescription medication for this condition, in order to gauge preference for oral or injectable administration for the treatment of hypercholesterolaemia.

Results

Patients

• Patients in EU5 at high or very high risk for CVD currently on prescription medication for their elevated LDL-C said if they were to take prescription medication to help control their cholesterol they have a general preference for a single pill taken orally over an injection given by a healthcare professional at their practice to help control their cholesterol (92% vs. 5%) – 3% have no preference.
• Presented with a scenario where a healthcare professional recommends an add-on prescription medication to further help control their LDL-C, 63% of patients who are at high or very high risk of a CVD would prefer a single pill taken orally each day versus an injection given twice a year by a healthcare professional at their practice (28%).
• Patients with a preference for a single pill as an add-on medication to help control their cholesterol are more likely to not change their mind versus those who prefer an injection twice yearly. And 51% of patients would insist on their preference for a single pill taken once daily vs. 42% would insist on their twice-yearly injection preference.
• For patients, the “ease of taking” and “being comfortable with taking pills” are the two most picked reasons (each 58%) for their preference for a single pill taken orally over an injection twice a year as an add-on medication to take along with the prescription medication they are currently taking to help control their cholesterol.
• Patients who are currently only taking a pill to help control their cholesterol are more likely to be very satisfied with their current prescription medication (20%) vs. those currently receiving an injection (1%), these patients are also more likely to state that their current prescription medication is very easy to use if they are currently taking a pill (60%) vs. those who are receiving an injection (20%).
• Patients in EU5 at high or very high risk of CVD who currently receive prescription medication for their LDL-C would prefer a single combination pill (62%) over an additional mono-medication single pill (17%; 16% had not preference, 5% did not know). This is according to a scenario, if a healthcare professional recommends that they take additional medication to help reduce their cholesterol further, either out of an additional mono-medication single pill (meaning a total of 3 pills daily) or a single combination pill (meaning a total of 2 pills daily).

HCPs

• Overall, 47% of the surveyed HCPs when presented with the scenario (shown below) and asked for their preferred mode of action chose an injection to be given by a healthcare professional twice yearly as an add-on to current prescription medication to further decrease LDL-C when goals were not reached, while 42% prefer an oral single pill to be taken once daily (10% had no preference, 1% did not know).

Scenario presented:

Two pharmaceutical companies are launching new prescription medications for patients with hypercholesterolaemia or mixed dyslipidaemia at high or very high risk of cardiovascular disease (CVD). These new prescription medications will be taken as an add-on along with current prescription medication to further decrease their low-density lipoprotein cholesterol (LDL-C) if LDL-C goals were not reached.

One company will launch an oral single pill to be taken once daily, while the other company will launch an injection to be given by a healthcare professional twice yearly at their practice, both as an add-on along with current prescription medication to further decrease LDL-C.

• Among the different specialty areas to which surveyed HCPs belonged, cardiologists and specialists prefer the twice-yearly injection as an add-on to further reduce LDL-C, while surveyed PCPs notably prefer the single pill taken once daily (52% pill vs. 39% injection). (Specialists in this survey included endocrinologists, diabetologists, lipidologists and internists with a secondary specialty in these areas).
• In Germany, UK and Italy, HCPs surveyed (all specialties) prefer a once-daily single pill taken orally as an add-on to further reduce cholesterol versus the injection twice per year (50% vs. 36%; 45% vs. 41%; 48% vs. 44%, respectively).   
• Of those HCPs surveyed who prefer a twice-yearly injection as an add-on to current prescription medication for their patients with hypercholesterolemia or mixed dyslipidaemia at high or very high risk of CVD, the top selected reason for the preference is “better patient adherence” (91%) while the main reason to prefer a single pill taken orally once daily is “easy for patients to take” (81%).
• Among specific answers to above question, and relating to the burden for the healthcare system a higher proportion of the HCPs surveyed who state a preference for the single pill base their decision on the assessment that a single pill would be “less [of a] time burden” (41%) and “less [of a] cost burden” (34%) for healthcare vs. 25% and 20%, respectively for the same reasons of those preferring injection.

HCPs were shown profiles of four different products (three in France)

• Product X (Single pill taken orally once daily) as an add-on to current prescription medication,
• Product Y (Fixed Dose Combination with ezetimibe single pill taken orally once daily) as an add-on to current prescription medication
• Product M (Injection twice per year given by a healthcare professional in practice) as an add-on to current prescription medication
• Product Z (Injection pen every 2 weeks self-administered) as an add-on to current prescription medication (not shown in France)

Link to full profiles below.

• When asked how likely or unlikely HCPs would be to prescribe each of the medications as an add-on to current prescription medication for hypercholesterolemia or mixed dyslipidaemia patients at high or very high risk of CVD in order to further reduce their LDL-C if LDL-C goals were not reached, 83% of HCPs indicated they would be likely to prescribe Product Y (Fixed Dose Combination with ezetimibe single pill taken orally once daily) (49% fairly and 34% very likely), 79% of HCPs likely to prescribe Product M (Injection twice per year given by a healthcare professional in practice) (31% fairly and 48% very), 78% of HCPs would be likely to prescribe Product X (Single pill taken orally once daily) (fairly 50% and 28% very likely) and 64% of surveyed HCPs - excluding France - are likely to prescribe Product Z (Injection pen every 2 weeks self-administered) (39% fairly and 25% very likely).
• After seeing the full product profiles, 49% of HCPs surveyed would prefer to prescribe Product M (Injection twice per year given by a healthcare professional in practice) as an add-on to prescription medication for hypercholesterolaemia or mixed dyslipidaemia patients at high or very high risk of cardiovascular disease (CVD) in order to further reduce LDL-C if LDL-C goals were not reached, while 38% would prefer a pill, 19% prefer Product X (Single pill taken orally once daily) and 19% prefer Product Y (Fixed Dose Combination with ezetimibe single pill taken orally once daily), 9% would prefer Product Z (Injection pen every 2 weeks self-administered – not asked in France).
• When HCPs were asked which of the prescription medications they thought most of their patients would prefer as an add-on to current prescription medication, 43% picked Product M (Injection twice per year given by a healthcare professional in practice), 25%  Product Y (Fixed Dose Combination with ezetimibe single pill taken orally once daily), 24% Product X (Single pill taken orally once daily),  and 4% Product Z (Injection pen every 2 weeks self-administered - not asked in France) - 3% had no preference and 3% don’t know.
• HCPs who stated their patients would prefer a single pill, gave as a reason for their assessment that (for both, Product X, Single pill and Product Y, Fixed Dose Combination with ezetimibe single pill – both taken orally once daily) a single pill was easier for patients to take (76%, 72%). For product M (Injection twice-yearly given by a healthcare professional in their practice), the perceived reason for patient preference is due to patients preferring twice year vs. daily oral medication (75%), while preference for product Z (Injection pen every 2 weeks by self-administration - not asked in France) is due to patients maybe forgetting to take the pills (48%).
• HCPs surveyed would change their treatment preference to an oral pill over an injection if it offered better efficacy (74%) or better safety (70%). Surveyed HCPs who prefer an oral pill would change their preference to an injection if it offered better efficacy (76%) or better safety (53%).
• In a situation where only oral products became available as an add-on to current prescription medication for patients with hypercholesterolaemia or mixed dyslipidaemia to help further reduce their cholesterol, 56% of surveyed HCPs would prefer product Y (Fixed Dose Combination single pill with ezetimibe single pill taken orally once daily) vs. product X (Single pill taken orally once daily) (31%) – 11% have no preference and 2% did not know.

Technical note

Ipsos conducted two online surveys in the EU5 for for Daiichi Sankyo. 1) among 1381 patients with high blood cholesterol at high/very high risk of CVD taking prescription medication for this condition and who were able to take part in an online survey. 2) among 751 HCPs including cardiologists (in UK, non-interventional only), GPs/PCPs and specialists (endocrinologists, diabetologists, lipidologists and internists with a secondary speciality in these areas), who chose to take part and met specific screening criteria. Fieldwork was conducted between 25th March and 9th June 2020. Full technical note available below.