Perception Consultation Treatment Delivery Compliance Evaluation

Perceive they have condition

Consult their doctor about condition

Receive a prescription

Fill the prescription

Actually take the medication

Intend to refill prescription

Source: Lilly ICOS.

The results revealed that fewer than half of those who perceived they had ED consulted a physician and that the type of physician consulted varied by country (Exhibit 7a). A variety of factors were found to influence ED patients to seek treatment (Exhibit 7b), with spouse or sex partner the most highly cited. Probing on the barriers to seeking treatment revealed that different reasons figured prominently depending on age (see Exhibit 8). In particular, younger men expressed higher levels of embarrassment in talking about the condition and were waiting for it to go away, while for older men the belief that this was a normal phenomenon of aging seemed to create a reluctance to seek treatment. According to the study, for those who did seek treatment, Viagra was the most commonly suggested medication. Most patients filled the first prescription they received (see Exhibit 9 for information on the location and payment for the prescription).

The level of satisfaction with Viagra, among all those who had tried it, was measured. The results, presented in the table below, revealed that a substantial percentage of males were not entirely satisfied with Viagra.

Table A Satisfaction with Viagra

Future intent to use Viagra was broken down into three groups based on past usage behavior: Viagra current users, Viagra dropouts (used Viagra at least once in the past but discontinued usage), and those who had never used Viagra. In the United States, 91% of current Viagra users expressed high/very high intent to continue taking the drug in the future, 46% of Viagra dropouts reported high/very high intent to use the drug in the future, and only 39% of those who never tried Viagra reported intent to ask for it in the future. The trend was similar in other countries.

The second set of issues in the survey explored more directly how the end patient would value Cialis. Respondents first gave their relative importance for four different attributes associated with an ED drug. The results were broken down by Viagra usage (see Exhibit 10). In addition, subjects were asked for their interest in trying Cialis in the future (based on the drug’s written profile). The relatively high willingness to try Cialis across countries (see Table B) was encouraging.

Table B Interest in Trying Cialis (%)a

Source: Lilly ICOS.

aPercentages represent respondents who agreed or strongly agreed with the statement: “I am willing to try this new drug.” Written profile described Cialis as having a 30-minute onset time, allowing a 24-hour window of opportunity, and that it could not be taken with nitrate.

The extensive survey was also complemented by more qualitative input. Mark Blakely, who was managing GMR’s involvement with Cialis, helped the product team conduct a series of 45-minute in-depth interviews with ED patients. Even though half of those interviewed were current Viagra users and half non-Viagra users (with a mix of Viagra dropouts and those who never tried the drug), Blakely was struck by the common “downward spiral” dynamic characterizing the ED condition:

The interviews revealed that in most ED cases, when a man first experiences inconsistent ability to perform sexually, there is feeling of personal embarrassment. If the condition persists, the individual often begins questioning his role in the relationship, accompanied by a sense of unfairness to the female partner; the relationship may become strained. Over time, not only does the ED patient feel insecure and detached from his partner, but his self-identity suffers. This causes him to question his role in other contexts of his life, including his interactions with friends or even colleagues at work. Thus, what started as a relatively noncritical physical condition spirals into a psychological anxiety problem considerably affecting the individual’s identity and even his sense of place in the world. Clearly, there appeared to be more associated with ED than a sufferer’s inability to get an erection.

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