Estimating new product uptake with the use of system dynamics:
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Datensatz im Suchindex
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| adam_text | Titel: Estimating new product uptake with the use of system dynamics
Autor: Ambroz, Kristjan
Jahr: 2009
Table of Contents
Erklarung.........................................................................................................ii
Table of Contents............................................................................................iii
List of Figures.................................................................................................ix
List of Tables................................................................................................xiii
List of Equations...........................................................................................xiv
0. Abstract......................................................................................................xv
1. Summary......................................................................................................I
1.1. Aim of the Dissertation..........................................................................1
1.2. Current State of the Market / Research..................................................1
1.3. Methodology.........................................................................................3
1.4. Contribution of the Dissertation.............................................................3
1.5. Research Results....................................................................................4
1.6. Use of System Dynamics.......................................................................6
1.7. Conclusions and recommendations........................................................7
2. Introduction..................................................................................................9
2.1. State of the Advanced Drug Market.......................................................9
2.2. System Dynamics................................................................................12
2.2.1. System Dynamics - Introduction..................................................12
2.2.1.1. Dynamic Complexity.............; ...............................................14
2.2.2. Modelling.....................................................................................15
2.2.3. What Can System Dynamics Bring?.............................................16
2.2.3.1. Creating a Shared Understanding...........................................16
2.2.3.2. Creating a Shared Language...................................................1 7
2.2.3.3. Conflict Resolution................................................................I X
2.2.3.4. Implementation......................................................................IS
2.2.3.5. SD as a Flight Simulator........................................................19
2.2.4. Limitations to Modelling with SD.................................................19
2.3. Patient. Physician and Client Confidentiality.......................................21
2.3.1. Steps for Ensuring Patient and Physician Confidentiality..............21
2.3.2. Steps for Ensuring Client Confidentiality......................................22
2.3.3. Steps Used to Sanitise Study B (2006)..........................................23
2.4. Structure of the Dissertation................................................................25
2.4.1. Chapter 3 -Current State of Research..........................................25
2.4.2. Chapter 4 - Methodology.............................................................25
2.4.3. Chapter 5 - Study B (2006) Analysis............................................25
2.4.4. Chapter 6 - Simulation Model......................................................26
2.4.5. Chapter 7 - Simulation Results.....................................................26
2.4.6. Chapter 8-Conclusion.................................................................27
3. Current State of Research...........................................................................28
3.1. Conventional Approach for Estimating New Drug Uptake...................28
3.2. Analogue Approach to Estimating New Drug Uptake..........................30
3.2.1. Justification for the Analogue Approach.......................................30
3.2.2. Elements of the Analogue Approach.............................................31
3.2.2.1. The Performance of the Precursor Drug.................................33
3.2.2.2. The Time of Loss of Exclusivity............................................34
3.2.2.3. The Competitive Marketplace................................................35
3.2.2.4. Pricing Information................................................................36
3.2.2.5. The Launch Marketing Strategy.............................................37
3.2.2.6. The Analogue Uptake Profiles...............................................38
3.2.2.7. External factors......................................................................40
3.3. Peculiarities of the Advanced Drug Class - Why the Analogue
Approach did not Work..............................................................................41
3.4. Other Approaches Used for Estimating New Product / Category Uptake
...................................................................................................................42
3.4.1. Bass Diffusion Model...................................................................42
3.4.2. Application of System Dynamics to New Drug Uptake Estimation
...............................................................................................................45
3.4.2.1. Dynamic Modelling of Pharmaceutical Marketplaces............45
3.4.2.2. Patient Flows.........................................................................47
3.4.2.3. Other System Dynamics Applications of Patient Flow-
Modelling...........................................................................................50
3.5. Literature Gap and Aim of Dissertation...............................................51
3.5.1. Research Gap - Uptake of New Product Classes...........................52
3.5.2. Research Gap - Benefits of a System Dynamics Approach in
Modelling a Sufferer Universe................................................................53
3.5.3. Areas Not Covered by the Research Project..................................54
4. Methodology..............................................................................................55
4.1. Scientific Positioning...........................................................................56
4.1.1. Voluntarist / Determinist...............................................................57
iv
4.1.2. Ideographic / Nomothetic..............................................................58
4.1.3. Humanistic / Positivist..................................................................58
4.1.4. Nominalist/ Realist......................................................................58
4.2. Research Design..................................................................................59
4.2.1. Introduction..................................................................................59
4.2.2. Purposes of Social Science Research............................................59
4.2.3. Research Designs..........................................................................60
4.2.3.1. Surveys..................................................................................60
4.2.3.2. Experiments...........................................................................61
4.2.3.3. Case Studies...........................................................................62
4.3. Main Data Source Methodology Options.............................................64
4.3.1. Hierarchy of Evidence..................................................................64
4.4.2. Use of Observational Studies........................................................66
4.5. Study B Design....................................................................................68
4.5.1. Scope of Study B..........................................................................68
4.5.2. Detailed examination of Study B (2006) Design...........................69
4.6. Alternative Study Designs Available...................................................72
4.6.1. Discussion of Study A (2006).......................................................72
4.6.2. Discussion of Study C (2006).......................................................75
4.6.3. Discussion of Study D (2004).......................................................76
4.7. Validation............................................................................................81
4.7.1. System Dynamics Model Validation - Introduction......................81
4.8. Replicable, Cumulative and Refutable.................................................83
4.8.1. Replicable.....................................................................................83
4.8.2. Cumulative...................................................................................84
4.8.3. Refutable......................................................................................84
5. Study B (2006) Analysis.............................................................................86
5.1. Disease Severity..................................................................................87
5.1.1. Physician Assessed or Objectively Measured Disease Severity?... 87
5.1.2. Physicians Assessment of Objective Disease Severity Measures .88
5.1.3. Physicians Assessment of Severity..............................................89
5.2. Disease Severity as Used in the Modelling Work.................................92
5.3. Disease Progression.............................................................................94
5.4. Treatment Persistency and Flow Derivation.........................................95
5.4.1. Deriving Flows from Study B (2006) Stock Information...............95
5.4.1. Definition of a Treatment Change.............................................95
v
5.4.2. Deriving Flow Data from Study B (2006).................................98
5.4.3. Derivation of Treatment Persistency.......................................101
5.5. Patient Projection Methodology.........................................................107
6. Modelling and Validation.........................................................................1 H
6.1. Main Stock and Flow Architecture....................................................112
6.1.1. Undiagnosed Sufferers before Presenting....................................116
6.1.2. GP Treated Sufferers..................................................................118
6.1.3. Specialist Treated Sufferers........................................................120
6.1.3.1. Specialist Care - Introductory Treatment.............................120
6.1.3.2. Specialist Care - Classical Systemic Treatment...................121
6.1.3.3. Specialist Care - Treatment on Advanced Drugs..................123
6.1.3.4. Specialist Care - Conventional Systemic Treatment for
Advanced Drug Experienced Patients...............................................124
6.2. Modelling Details..............................................................................127
6.2.1. Incidence....................................................................................127
6.2.2. Disease Incidence when Compared to Prevalence and Mortality. 128
6.2.3. Untreated Population..................................................................134
6.2.3.1. Initial Value.........................................................................134
6.2.3.2. Flows...................................................................................137
6.2.3.3. Disease Progression.............................................................140
6.2.3.4. Treatment Starts...................................................................145
6.2.4. GP Treated Population................................................................146
6.2.5. Specialist Treated Sufferer Population........................................149
6.2.5.1. Entry Class Treatment Stocks..............................................150
6.2.5.2. Conventional Systemics Treatment Stocks...........................156
6.2.5.3. Lines of Treatment of Conventional Systemics....................157
6.2.5.5. Initial Stock Levels of Systemically Treated Patients...........171
6.2.5.6. Distribution of Initial Stock of Systemically Treated Patients by
Line of Treatment and Speed of Treatment Progression....................181
6.2.5.7. Outflows to Advanced Drug Treatment................................186
6.2.5.8. Stock of Sufferers Treated on Advanced Drugs....................193
6.2.5.9. Inflow of Patients into the Advanced Drug Treatment Stock 194
6.2.5.10. Initial Value of the Advanced Drug Treated patient Stock.. 205
6.2.5.11. Post Advanced Drug Treatment Stock of Patients..............209
6.3. Summary of Main Stock and Flow Architecture Validation...............211
6.3.1. Direct Structure Tests.................................................................212
VI
6.3.1.1. Structure Confirmation Tests...............................................212
6.3.1.2. Parameter Confirmation Tests..............................................214
6.3.1.3. Direct Extreme Condition Tests...........................................215
6.3.1.4. Dimensional Consistency Tests............................................216
6.3.2. Structure Oriented Behaviour Tests............................................217
6.3.2.1. Extreme Condition Tests......................................................217
6.3.2.2. Behaviour Sensitivity Tests..................................................219
6.3.2.3. Boundary Adequacy Tests....................................................220
6.3.2.4. Phase Relationship Tests......................................................222
6.3.2.5. Turing Test..........................................................................223
6.3.3. Behaviour Pattern Tests..............................................................223
7. Model Results..........................................................................................226
7.1. Comparison of Baseline Scenario and Market Forecasts....................228
7.1.1. Growth Potential of the Advanced Drugs....................................228
7.1.2. Implications of the Baseline Scenario on the Patient Sourcing Pools
.............................................................................................................230
7.2. Scenario and Initiative Testing...........................................................235
7.2.1. Advanced Drug Leverage Analysis.............................................235
7.2.1.1. Effectiveness of Varying Share of Capture...........................237
7.2.1.2. Effectiveness of Varying Persistency...................................239
7.2.1.3. Effectiveness of Varying Early Treatment Failure Probability
.........................................................................................................241
7.2.1.4. Effectiveness of Delaying Competitive Entry.......................243
7.2.1.5. Effectiveness of Advanced Drug Market Levers - Conclusion
.........................................................................................................245
7.2.2. Market Growth with Relaxed External Constraints.....................245
7.2.2.1. Effectiveness of Improving Diagnosis and Referral Rates....246
7.2.2.2. Effectiveness of Changing Traditional Systemic Drug Use
Patterns.............................................................................................249
7.2.2.3. Effectiveness of Increasing Advanced Drug Adoption.........251
7.3. Discussion of Model Results..............................................................261
7.3.1. Summary of Model Results.........................................................261
7.3.2. End Consumer Initiatives............................................................265
7.3.3. PCP Initiatives............................................................................266
7.3.4. Specialist Targeted Initiatives.....................................................268
7.3.5. Initiatives Influencing the Regulatory Framework......................269
vii
7.4. The Use of System Dynamics as an Organising Framework..............271
7.4.1. The Use of System Dynamics for Data Source Triangulation......272
7.4.2. The Uses of Problem Specific and Whole System Models..........274
7.4.3. Uses of Small, Problem Based Models........................................275
7.4.3.1. Determining Detail Level Adequacy in the Full Model........275
7.4.3.2. Providing Guidance on Selecting the Best of Conflicting Data
Sources.............................................................................................276
7.4.3.3. Small Models as a Fast Prototyping Tool.............................277
7.4.4. Uses of Complete System Models...............................................278
8. Conclusion...............................................................................................280
8.1. Likely Uptake of Advanced Drugs Going into the Future..................280
8.2. Applicability to Other Product Areas.................................................282
8.3. Conclusions for the Use of System Dynamics as an Organising
Framework...............................................................................................283
8.4. Areas for Further Research................................................................284
8.4.1. High / Low Share Advanced Drug Prescribing Physicians..........284
8.4.2. Fast / Slow Moving Patients........................................................286
8.4.3. Epidemiology Review.................................................................288
9. References................................................................................................290
vni
List of Figures
Figure 1: Simple stock and flow representation..............................................13
Figure 2: Linear view of the world.................................................................14
Figure 3: Simple feedback..............................................................................15
Figure 4: Bass Diffusion Model......................................................................43
Figure 5: Standard Template Dynamic Modelling Framework.......................46
Figure 6: Simplified stock and flow representation of the sufferer universe.... 48
Figure 7: Burrell and Morgan (1979) Framework as adapted by Hamann (2006)
.......................................................................................................................56
Figure 8: Position of SD Research on the Burrell and Morgan (1979)
Framework (Source: Lane, 2001a).................................................................57
Figure 9: Composition of Study D (2004) sample...........................................78
Figure 10: Comparison of treatment distributions between Study D (2004) and
Study B (2006)...............................................................................................79
Figure 11: System Dynamics validation framework.......................................82
Figure 12: Comparison between severity split as determined by objective
measures and physician s own assessment of the same patients......................90
Figure 13: Severity distribution of the overall diseased population.................93
Figure 14: Reassigning patient records to comply with line of treatment
definition chosen - sample quarter of Study B (2006) data.............................97
Figure 15: Derivation of flow information from Study B (2006)....................99
Figure 16: Time disconnect between stocks and flows in analysing Study B
(2006) results...............................................................................................100
Figure 17: Summary of persistency data based on treatment cohorts from Study
B(2006).......................................................................................................103
Figure 18: Estimation of treatment persistency - the cohort method.............105
Figure 19: Summary of individual treatment cohorts and the overall derived
persistency...................................................................................................106
Figure 20: Including physician weighting in the Study B (2006) results.......109
Figure 21: Main model patient flow architecture..........................................113
Figure 22: Summary of the untreated / undiagnosed section of the model.... 118
Figure 23: Complete view of the GP treated section of the model.................120
Figure 24: Complete patient pathway architecture........................................125
Figure 25: Switching off incidence...............................................................132
ix
Figure 26: Changing incidence to match overall mortality............................132
Figure 27: Comparison of diseased population between the complete and
simple validation models..............................................................................133
Figure 28: Typical disease progression patterns............................................136
Figure 29: Deriving an age adjusted death rate.............................................139
Figure 30: Flows for disease progression......................................................140
Figure 31: Screenshot of Disease progression testing model.........................143
Figure 32: Comparison between model generated and Study B (2006) derived
specialist treated market disease severities...................................................148
Figure 33: Entry class treatment architecture................................................151
Figure 34: Derivation of fast moving / slow moving entry class patient inflow
split..............................................................................................................154
Figure 35: Summary of the entry class specialist market..............................155
Figure 36: Hypothesis on treatment persistency on systemic drugs...............159
Figure 37: Persistency of fast and slow moving systemically treated sufferers
.....................................................................................................................161
Figure 38: The inflow split between fast and slow moving systemically treated
patients by line of treatment.........................................................................163
Figure 39: Time of treatment on a line of systemics as a function of patient and
physician characteristics (Study B, 2006).....................................................166
Figure 40: Example of comparing treatment times between subsequent lines of
treatment for individual patients (Study B, 2006).........................................168
Figure 41: Variation of stock and outflow disease severity depending on
progression fractions....................................................................................170
Figure 42: Distribution by physician type in the overall country physician
universe........................................................................................................172
Figure 43: Distribution by physician type in the Study B physician universe 172
Figure 44: Comparison of workload concentration between Study B and overall
country estimates based on sales numbers....................................................173
Figure 45: Estimating overall systemically treated patient numbers from sales
numbers.......................................................................................................175
Figure 46: Summary of the estimation procedures for the initial value of the
systemically treated patient stock.................................................................177
Figure 47: Comparisons of the systemically treated stocks of patients between
three countries..............................................................................................180
Figure 48: Model used to estimate line distribution on systemic treatment... 183
x
Figure 49: Model generated and Study B derived line distributions on systemic
treatment......................................................................................................185
Figure 50: Required inflows into the stock of patients treated on advanced
drugs............................................................................................................189
Figure 51: Adjusted rates of initiation on advanced drugs............................191
Figure 52: Fast / slow mover patient split on advanced drugs as derived from
Study B........................................................................................................197
Figure 53: Patient Registry Report prevalence on advanced drugs................198
Figure 54: Summary of drug initiation split estimation procedure................200
Figure 55: Persistency for treatment stabilised patients on advanced drugs
going forward...............................................................................................203
Figure 56: Model generated advanced sufferer stock levels compared to those
of Planned Uptake........................................................................................204
Figure 57: Summary of inflow shares overall, on the first and on higher lines of
advanced drug treatment...............................................................................205
Figure 58: Inflow into the advanced drug treatment by line as fraction of total
inflow simulation.........................................................................................207
Figure 59: Comparison of Inflow versus stock splits of advanced drug treated
patients by line of treatment.........................................................................208
Figure 60: Summary of validation steps undertaken.....................................211
Figure 61: Validation steps undertaken by architecture stage........................225
Figure 62: Comparison of market forecast and baseline scenario advanced drug
uptakes.........................................................................................................229
Figure 63: Comparison of percentages of treatment changes ending up on
advanced drugs.............................................................................................230
Figure 64: Comparison of initiations onto systemic and advanced drugs......231
Figure 65: Development of the patient sourcing pool and line of treatment
within it........................................................................................................232
Figure 66: Severity distribution of systemically treated patients and importance
of disease progression versus inflow of new patients for the severity
distribution...................................................................................................233
Figure 67: Comparison of input and proportional integral tracking...............236
Figure 68: Effectiveness of varying share of capture....................................238
Figure 69: Effectiveness of long term treatment persistency changes...........240
Figure 70: Effectiveness of varying early treatment failure probability.........242
Figure 71: Effectiveness of delaying competitive entry................................244
xi
Figure 72: Framework for testing relaxed market constraints.......................246
Figure 73: Effects of increased referral rates to the specialist sector.............247
Figure 74: Leverage of increasing referrals of sufferers into the specialist sector
.....................................................................................................................248
Figure 75: Effectiveness of changing traditional systemic drug use patterns. 251
Figure 76: Summary of switch opportunities ending up as initiations on
advanced treatment.......................................................................................253
Figure 77: High versus low advanced drug prescribing physicians by overall
workload......................................................................................................254
Figure 78: High versus low advanced drug prescribing physicians by the
disease severity of their patient pool.............................................................255
Figure 79: High versus low advanced drug prescribing physicians by initiation
onto advanced drugs (Study B, 2006)...........................................................257
Figure 80: Effectiveness of increasing advanced drug adoption....................259
Figure 81: Summary of model results...........................................................262
Figure 82: Summary of model results - 10% leverage analysis....................263
Figure 83: Summary of model results - what change is necessary for the same
increase in patient numbers..........................................................................264
xn
List of Tables
Table 1: Differences between Consulting and Academic SD Applications.....62
Table 2: Hierarchy of evidence.......................................................................65
Table 3: Level of evidence for guideline recommendations (Hadorn et al, 1996)
.......................................................................................................................67
List of Equations
Equation 1: Basic Bass Diffusion Model Formula (Bass, 1969)......................42
Equation 2: Definition of treatment starts.....................................................145
Equation 3: Treatment starts definition in the validation case.......................146
Equation 4: Formulation for mild GP treated sufferer stock..........................147
Equation 5: Formulation for moderate GP treated sufferer stock..................147
Equation 6: Formulation for severe GP treated sufferer stock.......................147
Equation 7: Outflow from fast moving systemically treated sufferers...........158
Equation 8: Inflow into the second line of systemically treated sufferers......158
Equation 9: Example of outflow to advanced drugs from conventional
systemics......................................................................................................187
Equation 10: Inflow onto the first line of advanced drug treatment...............194
Equation 11: Inflow onto higher lines of advanced drug treatment (example of
2nd line)........................................................................................................195
Equation 12: First line advanced drug start equation for fast moving patients
.....................................................................................................................196
xiv
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| any_adam_object | 1 |
| author | Ambroz, Kristjan |
| author_facet | Ambroz, Kristjan |
| author_role | aut |
| author_sort | Ambroz, Kristjan |
| author_variant | k a ka |
| building | Verbundindex |
| bvnumber | BV035404495 |
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| ctrlnum | (OCoLC)317078406 (DE-599)GBV594737346 |
| discipline | Wirtschaftswissenschaften |
| format | Thesis Book |
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| genre | (DE-588)4113937-9 Hochschulschrift gnd-content |
| genre_facet | Hochschulschrift |
| id | DE-604.BV035404495 |
| illustrated | Illustrated |
| indexdate | 2024-07-09T21:34:28Z |
| institution | BVB |
| language | English |
| oai_aleph_id | oai:aleph.bib-bvb.de:BVB01-017325083 |
| oclc_num | 317078406 |
| open_access_boolean | |
| owner | DE-19 DE-BY-UBM DE-355 DE-BY-UBR DE-634 DE-384 DE-188 |
| owner_facet | DE-19 DE-BY-UBM DE-355 DE-BY-UBR DE-634 DE-384 DE-188 |
| physical | XV, 306 S. graph. Darst. |
| publishDate | 2009 |
| publishDateSearch | 2009 |
| publishDateSort | 2009 |
| record_format | marc |
| spelling | Ambroz, Kristjan Verfasser aut Estimating new product uptake with the use of system dynamics submitted by Kristjan Ambroz 2009 XV, 306 S. graph. Darst. txt rdacontent n rdamedia nc rdacarrier Sankt Gallen, Univ., Diss., 2008 3545 Innovation stw Innovationsdiffusion stw Markteintritt stw Pharmazeutische Industrie stw Pharmazeutisches Produkt stw System Dynamics stw Schätzung (DE-588)4193791-0 gnd rswk-swf Weiterentwicklung (DE-588)4461767-7 gnd rswk-swf Arzneimittelentwicklung (DE-588)4143176-5 gnd rswk-swf System Dynamics (DE-588)4058802-6 gnd rswk-swf (DE-588)4113937-9 Hochschulschrift gnd-content System Dynamics (DE-588)4058802-6 s Schätzung (DE-588)4193791-0 s Weiterentwicklung (DE-588)4461767-7 s Arzneimittelentwicklung (DE-588)4143176-5 s DE-604 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=017325083&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Ambroz, Kristjan Estimating new product uptake with the use of system dynamics Innovation stw Innovationsdiffusion stw Markteintritt stw Pharmazeutische Industrie stw Pharmazeutisches Produkt stw System Dynamics stw Schätzung (DE-588)4193791-0 gnd Weiterentwicklung (DE-588)4461767-7 gnd Arzneimittelentwicklung (DE-588)4143176-5 gnd System Dynamics (DE-588)4058802-6 gnd |
| subject_GND | (DE-588)4193791-0 (DE-588)4461767-7 (DE-588)4143176-5 (DE-588)4058802-6 (DE-588)4113937-9 |
| title | Estimating new product uptake with the use of system dynamics |
| title_auth | Estimating new product uptake with the use of system dynamics |
| title_exact_search | Estimating new product uptake with the use of system dynamics |
| title_full | Estimating new product uptake with the use of system dynamics submitted by Kristjan Ambroz |
| title_fullStr | Estimating new product uptake with the use of system dynamics submitted by Kristjan Ambroz |
| title_full_unstemmed | Estimating new product uptake with the use of system dynamics submitted by Kristjan Ambroz |
| title_short | Estimating new product uptake with the use of system dynamics |
| title_sort | estimating new product uptake with the use of system dynamics |
| topic | Innovation stw Innovationsdiffusion stw Markteintritt stw Pharmazeutische Industrie stw Pharmazeutisches Produkt stw System Dynamics stw Schätzung (DE-588)4193791-0 gnd Weiterentwicklung (DE-588)4461767-7 gnd Arzneimittelentwicklung (DE-588)4143176-5 gnd System Dynamics (DE-588)4058802-6 gnd |
| topic_facet | Innovation Innovationsdiffusion Markteintritt Pharmazeutische Industrie Pharmazeutisches Produkt System Dynamics Schätzung Weiterentwicklung Arzneimittelentwicklung Hochschulschrift |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=017325083&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
| work_keys_str_mv | AT ambrozkristjan estimatingnewproductuptakewiththeuseofsystemdynamics |