The NP/4P paradigm
Editor’s note: Michael Latta is executive director of YTMBA Research, and Dr. Murray Simon is president of D/R/S HealthCare Consultants. For more information call 717-229-0701.
New product/drug launch research methodology has been going through a process of evolution for a long time. Twenty-five years ago it was not uncommon for pre-launch strategy research to consist primarily of a series of focus groups with appropriate medical professionals in four or five cities with an emphasis on questions such as: What do you like about this drug? What do you dislike about it? If it were to become available tomorrow, what is the likelihood you would prescribe it? What patients would you prescribe it for? What patients would you not prescribe it for? What drugs currently in use might it replace? And (by the way) which of these three ads do you like best?
In years gone by, many a drug was launched with little more than a qualitative attitudinal study as described above coupled with a pricing study. But given the competitive nature of today’s drug market, with so many therapeutic entities competing for the physician’s (and the patient’s) attention and with the cost of new drug development so high, pharmaceutical clients are demanding a much greater degree of marketing guidance and predictability from their market research studies. As qualitative researchers, the onus is on us to be innovative and analytical. The days of qualifying every statement in a qualitative report with “suggests that” or “may be indicative of” coupled with a liberal assortment of “insightful” verbatims are over: most pharmaceutical clients expect qualitative research to provide analytical commitments and our relative success as researchers depends on it.
The NP/4P paradigm
We have been working on a research model for developing new product/drug launch strategies utilizing a pre-launch, four-phase program that begins and ends with qualitative research. The NP/4P paradigm represents a combination of older, proven methodologies and new ideas structured within a specific format and time frame (usually six months), resulting in a body of information that represents an opportunity for pharmaceutical companies to develop successful positioning strategies capable of maximizing:
- new product awareness;
- early trial and adoption;
- success in the pharmaceutical marketplace.
NP/4P paradigm — phase I: The first research phase, in which the most effective natural positioning of a pre-launch Product X is determined. It focuses on identifying:
- provider connectivity with product attribute claims (sometimes obvious, often subtle);
- perceptions of benefits these attributes may (or may not) bring to the patient and physician; and
- the medical and personal values held by physicians with regard to specific therapeutic categories and drug classes and how these values might influence prescribing decisions.
The resultant output of phase I is a natural positioning statement and supporting messages that feature the physicians’ own words.
NP/4P paradigm - phase II: A discrete choice survey incorporating the results from phase I to develop an accurate model of the current market and determine how well the natural positioning of Product X will fit in with particular attention paid to potential market share and cannibalization rates.
NP/4P paradigm - phase III: Data mining to develop database clusters of physicians who are likely to be early adopters, brand loyalists or late adopters. The discrete choice model data is used to generate specific physician profile categories for targeting purposes and developing a forecast of product uptake.
NP/4P paradigm - phase IV: The capstone phase, representing a final check of the combined results of the first three phases via a qualitative evaluation of the overriding natural positioning and its supporting messages.
Putting it to work
As an example, let’s suppose a client calls several months before a new cherry-flavored analgesic syrup (Product X) is to be launched. This product, a combination of a non-habit-forming nighttime sleep aid and a pain reliever, is for adolescent post-surgical patients. It will be marketed in an eight-hour, time-release formulation dosed at one teaspoon every eight hours for children between the ages of six and 12. The following is an example of the use of the NP/4P paradigm to develop marketing strategies in preparation for the launch of this product.
Phase I: natural positioning interviews
Natural positioning requires efforts to establish a link or series of links between a product and the potential end-users. Here we are concerned with the relationships between product attributes and benefits versus end-user needs and values. In the case of therapeutic agents, attributes gain relevance because they allow the patient to achieve certain benefits (e.g., pain relief, sleep, improved healing). Individual patient benefits, in turn, become important to physicians who have a more global need for those benefits (e.g., meeting the needs of an entire patient population, satisfying the Hippocratic oath of “First, do no harm.”).
The perceived inherent value of a drug can differ depending on the needs of specific physician types and their specialties. For example, Product X may be perceived to be of importance by pediatric surgeons because its pain reduction and sleep-inducing benefits will promote faster post-surgical healing. Pediatricians, on the other hand, may see it as a means of reducing the number of call-backs that often have to be dealt with during a busy day.
This analogous information is gathered through a qualitative interviewing technique that is similar to laddering. In laddering, the moderator first elicits attributes that are important to the physician followed by a rank ordering of those attributes. Then, by raising questions about why specific attributes are important to physicians, benefits and values are identified. Through this approach, it is possible to gain a reasonably valid understanding of how high prescribers of pediatric analgesics will position Product X in their pain-relieving armamentarium.
A laddering interview for a natural positioning for Product X might proceed as follows:
Moderator: You indicated that you prefer an analgesic with a sleep aid to one without. Why is that important to you?
Physician: It allows me to control pain through the night more easily.
Moderator: Why is controlling pain through the night of importance to you?
Physician: Well, because ultimately the patient is more comfortable overall when they can sleep through the night.
Moderator: Why is it particularly important for the patient to sleep through the night?
Physician: Because it improves that patient’s quality of life, healing is more rapid and I feel good when I can accomplish those goals.
Information from this qualitative interview allows us:
- to select product attributes for further study;
- to express product attributes in the language used by physicians;
- to define the range of attribute levels and to eliminate irrelevant levels.
The success of the subsequent phase II discrete choice model survey is directly related to the quality and comprehensiveness of the information gathered during phase I. Problems can arise when attribute ranges are too narrow or too broad and/or inappropriate or when vague language causes misunderstanding among physician respondents. In other words, the proper design of the discrete choice model survey (phase II) is highly dependent on the qualitative information gathered in phase I, i.e., beware of the GI/GO (garbage in/garbage out) monster.
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Before proceeding to phase II, an additional qualitative step is necessary to obtain the maximum input necessary to develop impactful natural positioning statements for Product X. This information is gathered through the use of projective techniques and one method that we have found to be particularly effective is central idea expression. In this approach, the moderator follows the attributes relationship discussion with a review of a new product profile. Utilizing the input from this product profile, the physician is instructed to complete the following steps:
1. Having read the profile, determine what is the central idea (or benefit) of Product X that first comes to mind.
2. The physician is asked to write this central idea in a circle on a sheet of paper.
3. The physician is then asked to write all other factors (using key words) that come to mind relative to the central idea, outside the circle.
4. The physician is instructed to connect related key words outside the circle with arrows that indicate a cause-and-effect directional flow culminating with the central idea benefit. (See illustration above.)
The result of this central idea expression exercise will now reflect what the most effective natural positioning and support messages for Product X will be and, in this case, might turn out to be:
- Natural position (the central idea): “The pain reliever that allows patients to sleep through the night.”
Supporting messages:
- “Good flavor improves compliance with younger patients.”
- “Whole-teaspoon dosing is easy to modify.”
- “Controls pain that interferes with sleep.”
- “Prevents breakthrough pain, allowing a full night’s rest.”
- “A liquid that is easier to swallow than a pill.”
- “All-night pain relief without drowsiness in the morning.”
Phase II: discrete choice model survey
Discrete choice model surveys utilize a patient allocation model in which physicians are asked to assign patients from certain sub-groups (post-operative, severe pediatric pain, moderate pediatric pain, non-surgical, etc.) to various products available for treatment. A schematic picture of the current market is generated, followed by a series of scenarios where Product X, in various configurations, is presented as an alternative therapeutic agent. The way in which shares shift (for example from Tylenol PM to Product X) shows the impact of the new product on prescribing patterns.
If a company such as Johnson & Johnson were sponsoring this study, cannibalization of Tylenol PM Elixir and Simply Sleep by Product X could both be measured along with price elasticity and the return on investment that would accrue to Johnson & Johnson through having all three products - a nighttime sleep aid alone, a four-hour branded acetaminophen with codeine product, and an eight-hour analgesic combined with a sleep aid - in the market at the same time.
The information generated by phase II can be used for segmentation, targeting, and estimating the level of cannibalization of existing brands caused by introducing a new competitive therapeutic agent. If segmentation, targeting, and an estimation of cannibalization rates are attempted without knowledge of the natural positioning (phase I) of Product X, the accuracy of the results of a discrete choice model survey will be highly questionable.
Phase III: data mining and targeting
Pharmaceutical companies have a long history of primary research with physicians, pharmacists, and nurses. These research efforts provide valuable insights into how professionals may be influenced to use or prescribe new products by providing an understanding of how they think, feel, and react to the diagnosis and treatment of medical problems such as post-surgical pain in pediatric patients. It does not, however, provide predictive models indicating the types of physicians who are most likely to initially try and to adopt new products. Data mining, on the other hand, uses the historical prescription data that manufacturers purchase from companies such as IMS and NDC in order to support the allocation of marketing resources through better segmentation and targeting of those physicians most likely to use new products.
Advanced predictive modeling techniques are used to understand the issues that a typical set of prescription spreadsheets cannot reveal. Pharmaceutical companies typically have Excel spreadsheets with thousands of individual physician records representing the moving annual total (MAT) prescriptions written for products such as analgesics used to treat pain and/or induce sleep. The main objective is to use that data to identify and profile the products that are the best targets from which to gain market share. A secondary objective is to identify holes in the market, i.e., those geographic or therapeutic segments where existing products have not achieved substantial penetration.
The process of data mining is a carefully planned search whose mission is to find valuables hidden from sight. . .as opposed to a haphazard statistical ramble in the dark. That search must be an informed one that is guided by the natural positioning of Product X (as determined during phase I) or it will miss the mark.
Phase IV: final positioning/main messages testing
By the time we get to phase IV, we have come full circle with a return to qualitative methodology (typically on the eve of launch). In this phase, we often utilize two qualitative methods:
1. Individual depth interviews to test the match between the product profile and the selected positioning statement; and test the match between the main positioning statement and supporting messages.
This testing can be done either through the use of advertising and promotional materials in a traditional message testing study or by using a master detail test video simulating how the positioning and supporting messages might be delivered to physicians. The video allows standardization of the message delivery much as showing a journal ad would. This research tells us how the position and supporting messages are likely to impact an individual physician’s initiative to try Product X. Reasons for and against cannibalizing in-line products can also be identified.
2. Mini-focus groups in a marketing war games exercise. Typically, a group of 10 physicians representing the target market are recruited. After an initial discussion of the therapeutic area and the current options available for the treatment of post-surgical pediatric pain, two groups of five physicians each are formed and seated in separate rooms. One group is instructed to examine the positioning and supportive messages for Product X and determine how best to convince the other group to undertake trial use and ultimately adopt the new product into their working drug armamentaria.
The second group is instructed to do the opposite, i.e., to take a competitor’s stance using the positioning and supporting messages to develop a convincing argument against the use of Product X. Given 30-45 minutes to develop their arguments, the two groups re-convene, debate the issues and try to determine which group developed the stronger argument and why. This research tells us how strong the arguments for and against Product X are likely to be during the launch phase and also allows us to develop opposing arguments to negate the potential influence of negative or competitive statements (a.k.a. marketing war games).
Conclusions
This article represents an effort to convey the importance of a rational and effective research method for creating successful marketing strategies for new drug product launches. Although the authors acknowledge that the NP/4P paradigm contains some components that have long been in use in health care marketing research, we also maintain that the use of these methods in a specific, clearly enumerated four-phase format can greatly relieve the eventual pain of a drug launch based on less compelling information. Companies that use the NP/4P paradigm to prepare for new drug launches will be rewarded by rapidly developing product awareness, early trial and adoption, and success in the marketplace.
Authors’ note: For those readers who like a good mystery but haven’t figured this one out yet, NP/4P stands for “natural positioning over four phases.”