Saving time and money using Conjoint in New Product Development

At CMR we are often asked how market research can help clients ensure they deliver products that genuinely meet the needs of the market.

Aside from using qualitative techniques to really dig into those needs, CMR are big advocates of conjoint analysis. Conjoint analysis is nothing new, dating back to the 1960s, but advances in software mean its use is no longer restricted to stuffy academics and statistical whizz-kids.

In simple terms conjoint helps us understand how differences in the features of a product affect consumer decision making. What features are going to make a patient select a particular blood pressure monitor? What will encourage an anaesthetist to use one spinal kit over another? 

The Conjoint approach enables us to model product features and understand the value that consumers place on each one relative to others. Every product has a range of features such as size, weight, material composition or price. For every feature there are numerous possibilities; the size of an insulin pen for example may be 10cm, 12.3cm or 15.6cm. Whilst these possibilities are endless, device manufacturers will always be working within the bounds of cost and technical feasibility, no doubt having a range of variants in mind. Gaining clarity around these variants to enable development of the most attractive product is the key benefit of conjoint.  

Conjoint analysis can provide answers that encompass a number of areas:       

Price – what is the price elasticity of demand? For which features will consumers pay a premium?

Utility – which features are most useful and provide greatest value to consumers? Which features are more influential when it comes to choice?

Overall profile – Which combination of feature levels will drive the greatest demand? What is the minimum acceptable profile in order to gain the required market share?

Conjoint analysis can also provide an insight into the likely performance of a product within an existing market. By feeding in the specific features of competitor products, it is possible to assess how consumers may react to a new product and the extent to which they may favour it over their existing choice. Likewise, if a manufacturer already has its own product in the market, conjoint analysis can be used to gauge the degree of cannibalisation that a new product may generate.  

In two recent projects carried out by CMR we have enabled clients to confidently and clearly settle on a set of features that they believe will give them the edge in their respective markets. The first was for an entirely new product, created from scratch following a qualitative exploration of unmet needs among surgeons. Once the surgeons had outlined their needs and defined the most desirable format for the product our client’s development team came up with a firm concept.

The Conjoint approach was used to pin down the specific feature levels, identifying the must-haves and delighters to settle on the most desirable product spec. 

In the second project the client was seeking to enter a highly competitive sector with a new, low-end product. Conjoint was used to identify which elements were critical and which could be sacrificed for a reduction in price.

“In a market where ill-judged product development can cost many millions of dollars, euros or pounds”, explains George Ashford, CMR’s MD, “ we believe the conjoint analysis approach represents a critical tool in the product development process”. 

Diabetes UK Professional Conference March 2013

This year three members of CMR took the trip to Manchester Central for the Diabetes UK Professional Conference. A huge, former railway station, the hall was filled with colourful stands – a particular favourite of ours was Lilly’s area, with a home setting including a living room, kitchen and garden. Massages were offered next to the fun zone (complete with air hockey!) at the hall’s front, with the rear of the hall reserved for academic posters in a maze-like setup, covering a massive range of topics. There was an interesting talk from Diabetes UK themselves on their community champions. Among other speakers, the Janet Kinson Lecture this year was by speaker David Simmons, entitled Peer Support in Diabetes.

Depression and stress are two major downfalls of being diabetic, and peer support has a definite positive impact according to three separate studies that were reported on: The Coventry Diabetes Study, New Zealand Maori Study and the University of Cambridge’s RAPSID Study. All looked to help undiagnosed diabetics discover their condition, whilst giving back to the community in the form of training for the unemployed, diabetes education and peer-support groups.

The three studies focused on ethnic minorities and deprived areas, where prevalence of diabetes tends to be higher, with peers able to build rapport with others from the same community. The findings of the study showed that psychosocial, psychological and physical issues were key barriers to seeking treatment, as well as a lack of education. This led the way for a diabetes care plan, on how best to tackle diabetes in the areas and where to seek advice and treatment.

Peer support had great effects on metabolic measurements such as HbA1c, as well as psychological health – showing considerably reduced rates of stress, depression and anxiety. More surprising was the low cost of peer-support groups in one of the studies, at just £6 per month – much cheaper than running regular counselling or clinical psychology services, along with the added benefits of more personal and open discussions. This could be a wake-up call to the UK’s National Health Service, which currently has little provision for long-term psychological support for diabetics.
 
Another highlight of the conference was the large number of manufacturers demonstrating their new products. We saw Spirit Healthcare’s blood-glucose meter with a voice for the visually impaired and Abbott’s new FreeStyle InsuLinx meter that offers dosing advice and holds a log of 3000 user events.

Ypsomed displayed some new, discreet mini syringes, conveniently designed to be filled with insulin and stored in the user’s pocket for subtle administration. The company spoke to us about their plans to incorporate CGM technology into Omnipod, with their ultimate goal being to provide the pump and sensor on a single cannula. Lilly’s exciting new HumaPen Savvio is a lighter, modern pen with a durable dial – and the range is as colourful as their stand! At the front of the hall was Mendor, showing an interesting integrated BG meter that includes a meter, test strips and lancing device all in one.

While we were at the conference, we also spoke with three young type-1 diabetic women, all of whom are ambassadors for Diabetes UK. Among them was a common anticipation for Cellnovo’s upcoming pump – it seems a world away from their initial reservations with pump therapy: constant attachment, a permanent lump, insecurities with durability. Hopes have been up for the pump since the original announcement of a May 2012 release date, although this was unfortunately pushed back to add more polish, and is now set for a 2013 release.

With this device, Cellnovo have a “dead funky” and “much slimmer” pump that looks discreetly like a mobile phone. Extendable tubing gives the user a customised length, and Velcro for flexibility. They say that aesthetic is everything when deciding pumps, and are impressed with its touch-screen interface and size. Cellnovo are also tipping their pump to be the first device to allow uploading of measurements to the cloud, making it accessible by the user’s physicians and parents remotely.

Two of the three girls are currently pump users, with the third due to start a six-month trial imminently. The two that are on pump therapy explained that the difference was night and day: “MDIs are uncontrollable” – multiple daily injections gave extremely volatile readings and caused near-permanent exhaustion.

Hannah, the youngest of the girls, was diagnosed sixteen years ago and decided she wanted a pump after years of imbalance. This process was particularly difficult due to the fight for NHS funding – a problem echoed by the others’ experiences.  Hannah spoke in detail about her life as a diabetic in her speech at the conference.

With a certain hype around Cellnovo and a new-found caring attitude among manufacturers towards patients’ experiences, Diabetes UK pulled off a great conference and attracted a diversity of visitors. It’s always nice to learn something new every day, so we’ll leave you with a little fact: H.G. Wells, author of important works including The Time Machine and The War of the Worlds, was himself diabetic and founded Diabetes UK as The Diabetic Association, back in 1934. Maybe a time machine wasn’t H.G. Wells’ greatest invention after all…

Report on ATTD, Paris Feb 2013

Updates on CGM - improved accuracy, benefits of using it continuously, the patient experience, new technologies

What makes ATTD different from other diabetes congresses is its focus on new technologies.

This year there was a lot of talk about CGM, mainly about its continued improvement in accuracy over the last few years, and evidence of its efficacy in reducing severe episodes of hypoglycaemia, especially in conjunction with the use of LGS (low glucose suspend) pumps.

John Pickup from London reported on a survey his team is doing with patients using a CGM. They have been recording their stories and it was fascinating to hear the benefits they are reporting from the continuous use of the sensors. Parents and carers are sleeping better in the knowledge that they don’t have to lie awake worrying about their child or partner; and substantial benefits were reported in improving glycemic control and quality of life.

The major downside of CGMs reported from John’s study, and from other speakers, was the limited amount of training received by both patients and HCPs in how to interpret the data. Doctors and patients need good training and regular contact, together with motivation on both sides to improve self management by patients

There is a huge amount of data generated by the sensors and it’s important for doctors to drill down, look at individual days, to find the story behind why particular highs and lows are happening, and then the patient has to know what bolus to give in response to the data.

Another downside, of course, is the current lack of reimbursement, and the fact that although the devices are improving in accuracy they are small improvements each time and what is really needed is a step change.

The key challenge to manufacturers it seems is not the chemistry, it’s making the device small enough to be unobtrusive. Reasons for limited use of CGMs are poor accuracy, poor user friendliness, too many false alarms, and cost.

Key Takeaway: The takeaway for manufacturers here is to make CGM data simpler to understand and use, and the sensor unobtrusive.

The patient experience - make things simpler, improve training, empowering patients to help them self manage

It was good to hear about the value of evidence that is the Voice of the PWD (and their carers). Several speakers gave the view that clinical evidence is all very well and good but that what is important is the way patients actually use devices in their daily lives and whether they do help improve the quality of life or hinder it, eg by making patients feel “different”, self conscious, “controlled” by diabetes, unable to make sense of so much data.

Ralph Ziegler, a German pediatric Doctor gave a fascinating talk about how CGM technology can help improve diabetes management in pediatrics. His message was that the “Holy Grail” - the closed loop system – is so called because it takes the decision making away from the patients so they can get on with their lives. 

He told us that what PWD hate is:

• ·         Pricking for SMBG
• ·         Fear of hypo’s
• ·         Looking different
• ·         Having to make the mechanical decisions of dosing

Professor Davis from Leicester is passionate about educating patients to help them self manage. In her words, monitoring BG is only the starting point. The challenge for manufacturers is how to display the information in a way that helps patients make positive changes in the management of their diabetes. She would like more work to be done to understand what patients want from SMBG devices, and what HCPs want.

She had a message for HCPs too – only a minority of patients get formal instruction on diabetes and how to use devices intelligently; it’s important to review patients’ data with them and use it as a teaching tool to enable them to understand what is going on in their own bodies. We need much better education of patients.

Jan de Vries , from Amsterdam, also spoke about empowering patients with technology, and we heard that in the Netherlands doctors receive reimbursement for e-consultations.

Key Takeaway: Diabetes is not just about numbers; technology also needs to address quality of life and ease of effective self management to empower patients

CGM in hospital

The use of CGM in hospital, and particularly within ICUs was another hot topic. We heard that 18-20% of inpatients in a London hospital have diabetes, 30-40% of patients in hospital (in the US) have hypoglycaemic events, and patients’ blood sugars rise with surgery. 

Additionally, severe hypoglycaemia is a risk factor for mortality in the critically ill. This all impacts on nurse time, longer hospital stays, and higher mortality rates.

The important thing in ICU is to minimise glucose variability and avoid hypo events. We heard that the thing that drives nurses mad with CGMs is the alarms that go off, most of which are false positives/negatives.

Key Takeaway: What is required in an ideal CGM system, according to Dr Holzinger from Vienna is one that is rapid, accurate, inert, robust, non invasive, cost effective.

Several different technologies were reported on, with varying levels of accuracy. Currently available CGM systems are IV and subQ, ie invasive, which brings risks of infection and thrombosis. 

Echo Therapeutics presented their non invasive (needle free), wireless, transdermal CGM that is being developed for use in hospital critical care units. Because it is non invasive there are no risks or discomfort associated with current needle-based CGM systems. The system is undergoing trials and is expected to be CE marked later this year.

New products that caught our eye  

We were interested to see the latest developments in the Debiotech Jewel pump. It’s not yet on the market but appears to have been well engineered, with some exciting features which address many of the still unmet needs of PWD. Having no tubes there is no kinking, occlusions or air bubbles. It’s really small, thin and lightweight and yet holds up to 500 units of insulin, meaning the patient can use the pump for 7 days without having to refill it. In addition the programmer is also a secure mobile phone and BG meter, making it discreet in the presence of other people. The device is in late stage development and hasn’t yet received CE marking or FDA clearance but the company intends to launch in the EU first, followed by the US.

The Cequr PAQ device is a very simple insulin patch pump designed to meet the specific needs of people with type 2 diabetes who could benefit from intensive insulin therapy.  People with type 2 diabetes often report skipping insulin injections. The device offers a simple basal delivery and push button bolus, needs no programming and takes just one hour to learn. It delivers 3 days of continuous basal insulin, with 7 different basal rates available, and a bolus with the push of a button. The device has CE marking and the company is looking to launch in Europe in 2013/14.

The Senseonics implantable CGM is designed to be the first fully implantable CGM system that is highly accurate and stable throughout its long sensor life. It stays under the skin for 6 months; it measures BG levels every few minutes and sends alerts for impending hyperglycemia and hypoglycemia. The mobile medical app uses a smartphone to receive and display the sensor glucose data from the Senseonics transmitter.

Dexcom presented their next generation sensor, the G4 platinum, said to be “the most accurate and easy to use CGM”, that will share data on the cloud with caregivers. We heard that it is expected to be included on the Animas and Tandem pumps in 12 months’ time.

The Sanofi iBGStar is a tiny blood glucose meter that connects seamlessly with an iPhone, which means you can view all your data in real time and share it with your HCP.

Promising findings may help boost the global telehealth market

With an ever ageing population the prevalence of chronic disease worldwide is increasing. In the UK alone at least 15 million people are thought to be living with at least one long term condition. Telehealth, defined as “the remote exchange of data between a patient and healthcare professional as part of the patient’s diagnosis and healthcare management” has been earmarked as one potential approach to the treatment of these patients.

Telehealth utilises technology to help patients self-manage their condition and live more independently, therefore improving quality of life for the patient and potentially reducing costs of secondary healthcare. However, historically, a lack of economical and long term clinical data has meant many have been reluctant to invest.

The Department of Health has estimated that in the UK at least 3 million people with long term conditions could benefit from telehealth services, and hence initiated the “Three Million Lives” campaign. Preliminary findings from their Whole System Demonstrator (WSD) programme, the largest global randomised control trial of telehealth and telecare, demonstrate that successful delivery of telehealth can significantly reduce mortality rates and emergency admissions, which just could be the justification the market is waiting for.

The WSD trial involved a total of 3,230 patients in the UK with chronic obstructive pulmonary disease, heart failure and diabetes; all chronic conditions associated with high prevalence and high healthcare costs. Half of patients acted as a control group receiving treatment through traditional methods, and the other half were delivered telehealth.

Patients receiving telehealth were taught how to monitor their condition at home and transmitted data to their health care professional. Although the specific telehealth device used by patients varied, all chronic obstructive pulmonary disease patients used a pulse oximeter, all diabetic patients used a glucometer, and all heart failure patients used weighing scales.

Results from the trial indicate when compared to the control group, telehealth patients experienced:

·         a 45% reduction in mortality

·         a 21% reduction in emergency admissions

·         a 15% reduction in A&E visits

·         a 14% reduction in elective admissions

·         14% fewer bed days

·         an 11% reduction in hospital admissions

Small differences in hospital costs (£188 per head lower for telehealth patients) were noted, however given that the actual cost of the telehealth treatments were not taken into account, this reduction is not considered significant enough to conclude that telehealth can reduce secondary care costs over 12 months. Cost-effectiveness will be assessed as a separate part of the WSD trial.

Despite this, these findings from the WSD programme provide the strongest evidence yet that telehealth can be linked to improved patient outcomes and the reduction of reliance on (costly) secondary care. According to InMedica forecasts, the impact of the 3 million lives campaign could potentially push the UK ahead in the global telehealth market, accounting for 74% of worldwide telehealth patient numbers by 2016, compared to 4% in 2010. These initial clinical results, and hopefully the impending economic benefits could provide the evidence base that many have been waiting for, and become a tipping point for wider adoption of telehealth worldwide.

Find the full BMJ article on the WSD findings at http://www.bmj.com/content/344/bmj.e3874

Find the InMedica article at http://in-medica.com/news-events/press-template.php?pr_id=2463&from=all_pr

Getting the needle with GLP-1 treatment

Whichever way you put it, it seems that many people with type 2 diabetes are getting the needle when it comes to their GLP-1 agonist therapy.


This is a very useful treatment in terms of its efficacy in lowering blood glucose levels and lack of association with weight gain, maybe even achieving weight loss, an important benefit for people with type 2 diabetes.
However, when we spoke to HCPs at our stand at EASD in October it was evident that the devices associated with it currently are far from ideal.

CMR’s John Reynard commented: “GLP–1 products for type 2 diabetes are clearly the new frontier in treatment and, if used correctly, can help a patient manage their diabetes and possibly avoid insulin injections but this is highly dependent on the patient being compliant with their medication.”
People with type 2 diabetes are not used to self-injection and the process has to be made as easy as possible for them. Furthermore taking a GLP-1 is the step taken when oral treatments like Metformin have not been successful for diabetes management, which suggests a history of non-compliance in either medication, diet, exercise, or all of the above.

Currently we have a trade off between a once a week injection with Amylin’s Bydureon, that involves a complicated 15 piece kit with a large needle capable of dispensing a higher viscosity; and the more convenient, prefilled, disposable smaller injection pens offered by Novo Nordisk’s Victoza or Amylin’s Byetta, which have to be injected daily or twice daily.

“We discovered that healthcare professionals frequently encounter concerns that patients either fear the idea of becoming drug dependent through daily injection or can be intimidated by the complexity of the 15 piece kit.”, added John.

“Through our own research with patients we understand the conflicting needs of managing diabetes – a disease that takes over a person’s life and takes a considerable amount of time and effort to manage properly, and a reluctance to embody the thought that they are different from their peers - and this requires devices that are both simple and discreet.”
Any comment would be welcome on the above from both manufacturers and HCP’s, this is very much the new frontier in diabetes and the more discussion and exchange we have the better.

Who is being left behind by the march of technology?

The ever onward march of technology is discriminating against large numbers of the global population as we discovered from questions we posed of healthcare professionals visiting our stand at EASD in Berlin last October.


When it comes to diabetes, a disease that predominantly affects people with low incomes and other disadvantages, the ability to self manage their disease could be a major factor in slowing down the epidemic.

According to latest figures from the IDF: “It is now recognized that it is the low- and middle-income countries that presently face the greatest burden of diabetes, where there is substantial evidence that diabetes is epidemic”

The problem is that manufacturers are in constant competition to develop ever more sophisticated devices, and often little thought is given to the presentation of educational materials for patients.
Kylene Ross, CMR’s US Development Manager, believes that manufacturers need to pay more attention to cultural nuances as well as issues of literacy and poverty that exist in many areas where diabetes is now taking hold.

“We asked a basic question of healthcare professionals every day during the conference: Who is not being considered (in technological development)?

“There was a range of answers: from illiteracy, lack of accessibility in more remote areas, to the physically disadvantaged, the aging population and people on low incomes not being considered.

“Because diabetes is such a far reaching disease it’s incredibly important for patients to be able to understand the nature and processes involved in their treatments and to have access and support regardless of their ability to use technology.

“From talking to HCPs from many different nations at EASD it’s also clear to us that there’s a big disparity in the availability of diabetes devices across the world, which reinforces just how different populations have such differing experiences of treatment,” added Kylene.

Now, more than ever, the way the industry communicates to people with diabetes must become more inclusive. Diabetes is now becoming a major issue in populations and cultures which were previously unaffected.

Again, from the IDF: “Within ethnic groups, high rates of type 2 diabetes are usually found in migrant or urbanized populations that may have experienced a greater degree of lifestyle change. The lowest rates are generally found in rural communities where people have lifestyles incorporating high levels of physical activity.”

It is time we in the West, take responsibility for having given our western lifestyle changes to the less developed nations, and do our part in helping to widen the access to treatment and devices by giving proper thought to their needs.

UK government's cash fund to help medical breakthroughs

Hundreds of millions of pounds will be invested in the UK life sciences industry to improve patient care and fund new medical breakthroughs, as the UK government announced the launch of its Life Sciences Strategy and a review of innovation in the NHS on 5 December.

According to a press release published on www.number10.gov.uk, the official website of the British Prime Minister’s office, key measures include:

• installing remote medical devices– such as home-based equipment that can send details of the vital statistics of at-risk patients directly to doctors – to 3 million people over the next five years

• consultation on proposals for a new “early access scheme” that will accelerate the introduction of new drugs and technologies in NHS hospitals

• a new £180 million fund to help the next generation of British medical breakthroughs become the next generation of great British companies.

Commenting on the plan, UK Prime Minister David Cameron is quoted as saying, “We can be proud of our past, but we cannot be complacent about our future. The industry is changing, not just year by year, but month by month. We’ve got a leading science base, four of the world’s top 10 universities and a National Health Service unlike any other. But these strengths alone are not enough to keep pace with what’s happening. We’ve got to change radically—the way we innovate, the way we collaborate, the way we open up the NHS.”

The UK life science industry, which includes pharmaceutical, medical technology and medical biotechnology companies, is one of the world leaders. It is the third largest contributor to economic growth in the UK, with more than 4,000 companies, employing around 160,000 people and with a total annual turnover of over £50 billion.