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Look closer - The importance of local opinion leaders

Published on 29/10/03 at 11:30am

There is no doubt that key opinion leader (KOL) development has always been a crucial component of the marketing mix; it is often regarded as the first tumbling domino in the chain reaction where high-value exposure, ideas and opinion (hopefully) cascade down to prescribers, decision makers and eventually the general public.

But for a few years now a new paradigm has been emerging and this has meant that the KOL, whatever the therapeutic area, is no longer so easily identifiable. If UK- based companies are to successfully target the KOLs of the 21st century, they need to consider the changing face of the NHS and the implications of this.

The impact on prescribing of formulary committees, fresh budgetary constraints, drugs and therapeutic committees and the increasing role of nurses and pharmacists in the decision-making process mean that companies have to develop the appropriate response to an evolving set of circumstances.

NHS evolution

Mike Sobanja, director of NHS strategy at HealthGain Solutions and chief executive of the NHS Alliance believes that companies now have to understand a far more complex definition of KOLs and prescribing practices in the UK.

"Ten years ago, the KOLs were clearly the hospital consultants and pharma was looking at a KOL cascade that would allow them to concentrate on those people in the knowledge that they would be able to roll out prescribing habits across primary and secondary care," he says. "I think that is changing and while Ive never been one of those people who says the world has changed radically overnight it's clear that we now have new opinion leaders coming onto the stage who will become more and more important over the years."

He argues that over the years pharma has had to change its tack in the search for the most effective KOLs with many of them now involved at a local level as opposed to a solely national level.

"One of the features of twenty years ago was that there was a single model that existed and pharma could apply that model virtually anywhere in the country", he explains. "Now they have to find the means of getting in and understanding the local health economy. This means quickly identifying who the KOLs actually are, what motivates them and what are the important local priorities that will influence prescribing (which could be outside of the health service as the pharma industry understands it, for instance in local government and local authorities). One model driven from the centre will no longer do, it has to be one that is sensitive to local circumstances."

He explains that while conditions such as coronary heart disease are obviously national priorities to the NHS and therefore shared right across the country, some of the industry's KOL strategies will depend upon local circumstances and need to be implemented slightly differently.

"It's about having a common thread with fuzzy edges - and it varies, depending not only on therapy and local priorities but also the local financial circumstances."

In the past, pharma has tended to build relationships with its favourite KOLs over a number of years and maintain them for new product launches. Mr Sobanja says that the new paradigm means that often, companies now have to build new relationships from scratch.

"Many of the better companies saw this shift coming ages ago and have altered their KOL development approach accordingly in the last three or four years," he says. "But it's not just about finding new people, the industry still has to maintain the older relationships with those who have served them well over the years".

Global or local opinion?

A recent report by US-based Cutting Edge Information reveals that there is still a gap in the use of KOLs at the local level. Although the companies surveyed said they used regional and national opinion leaders in 79 per cent of key marketing activities, only 54 per cent of those activities used local thought leaders.

The report warns companies that if they under-use local thought leaders' abilities, they risk reducing the effectiveness of opinion leader campaigns. It argues that local thought leaders are less costly to identify, can be very influential and very helpful in identifying local market needs and are in reality the "next wave of regional and national thought leaders".

The new opinion leaders and how to identify them

Mr Sobanja points to prescribing advisers and Primary Care Trusts in England and prescribing leads who are often GPs, as examples of new KOLs: "Clinical governance leads are also very important for the industry, often because the new payers are trying to influence prescribing across primary and secondary care. There are currently some instances where primary care is actually dictating prescribing in secondary care and not the other way around".

The industry is constantly looking for new ways of reaching the right experts for their products. From the more traditional methods of scouring the pages of peer-reviewed journals and outsourcing work to specialist agencies, companies are now developing electronic interactive KOL databases to find the right people.

By installing a centralised system, companies can not only address immediate needs, such as nailing down the correct speaker for a forthcoming symposium, but also identifying the up-and-coming KOLs and their potential sphere of influence. By being extra thorough, some companies are now unearthing the less obvious routes to KOL identification - relevant sub-committees, study groups, scientific journal editorial committees and lead authors in reputable studies.

Potential KOLs have to be comfortable with reviewing and advocating a company's evidence base. It is also important to evaluate the viewpoint and position of KOLs before sitting them down in front of a company representative. Agencies are often an effective way of gauging their standpoint on key brand and management issues, information that they may not want to disclose directly to a company.

Early involvement

Whatever methods companies are using to develop their KOLs, there is a growing consensus that timing plays a crucial part in maximising the value of a KOL relationship. According to the Cutting Edge report, brand teams gain more from thought leader liaisons the earlier in the drug life-cycle they start their development work.

Lead researcher on the report, Elio Evangelista says that while most companies are generally clued up on how to effectively identify, select and integrate their KOLs into programmes by phase II, many now want to get them involved earlier, in some cases as early as the pre-clinical stage.

"Because many products are scrapped before the end of phase I, there is a high risk in recruiting thought leaders earlier," he says. But he also points out that brand teams implementing a focused KOL development programme early develop the most beneficial relationships when the launch phase arrives.

The report states that by starting development work in phase I, companies can involve KOLs in activities that overlap phase I and phase II such as clinical trial work and publications planning. Even if the drug launch seems many light years and several hurdles away, this type of forward planning helps shape the products profile among its potential endorsers and prescribers, so when the big day does (hopefully) arrive, the marketing team will have a firmer foundation upon which to commence their campaigns.

Mr Evangelista is keen to stress that the most effective KOL development work is based on quality R&D rather than marketing prowess.

He says that KOLs on all levels, whether local or global, are attracted by the offer to research effective new treatments. This means companies need to promote the innovative science behind their product, rather than merely focusing on promotional campaigns. By giving KOLs these research opportunities, which allow them to increase their profile in the medical community and press, companies can reap the dividends by creating market awareness for their products.

Over the last few years, there has been a certain amount of conjecture over whether companies are guilty of over-exposing their KOL base. Obviously, management will often inherit their KOLs and will have to make key decisions about whether to run the risk of keeping them on-board or cutting the strings and searching for the new rising stars.

Mr Sobanja argues that the evolving nature of the KOL could work in the industry's favour in this respect. "The question of over-exposure is an interesting point because it actually raises the issue of what companies are using KOLs for" he says. "If you use KOLs to try and influence the market generally then yes, there is a danger of real over-exposure - we all turn up at conferences and hear the same speakers again and again and that can be very limiting".

He believes that by using KOLs to influence the local scene, companies run much less risk of over-exposing them nationally: "I suppose its possible to over-expose a KOL locally, but when they're in this scenario theyre likely to already be exposed in their local patches because of the very nature of their job. KOL development is not just about looking for the professionals who are going to do that bit extra for you, it's actually plugging in to their responsibilities and getting them to undertake those responsibilities in a way that is sympathetic to the product and the company".

Of course, KOL development is still a very sensitive nature, not only in the way links and relationships between the industry and the medical community can be perceived but also if it is undertaken overseas. Mr Sobanja talks about the 'ingrained scepticism' that some members of the NHS still harbour towards randomised controlled trials and KOL development outside of the UK.

It's a real problem for pharmaceutical companies", he says. "The UK represents 1-2 per cent of the global market and yet people in the UK are increasingly saying 'we want it done this way'! I often find myself having to persuade people in the NHS that they have to understand that in the bigger picture, people will respond to an international market".

He gives the recent example of a company displaying impressive randomised controlled trials for a product with patients running into thousands. The observers were impressed until they were told that only six of the patients came from UK trials and then their attitudes changed.

"I think there is a kind of attitude in the UK that always wants evidence to be displayed in a real life UK situation as opposed to somewhere in the States, for example".

According to Mr Evangelista, thought leader management works best when there's a co-ordinated effort throughout the company, directed by a centralised thought leader management function.

Key to this is the rationale of developing distinct strategies for each KOL segment. Mr Sobanja says that by moving with the times, the industry now has a real opportunity to shrug off what he describes as the 'questionable tactics' it was using 20 years ago to approach KOLs.

"The world's moved on and if the industry and the NHS continue to behave as if nothing has changed in 20 years, then there's a recipe for a real breakdown. It requires both sides to move forward and to try and develop a new and mature relationship built around common understanding and trust".

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