Article: Assessing demand in emerging markets

A strong understanding of local market characteristics is important, especially in the current world climate. If there is sufficient information within the company about these markets, these can be shared and incorporated before research is commissioned. If not, we recommend conducting stakeholder interviews prior to the full survey to help shape questionnaire design. Local factors to understand include: 

• Competitive set: In any market, there are always likely to be local competitors but in north Asia in particular, traditional medicines can be a competitor. For example, in Tier 3 hospitals in China, patients can be treated by both the oncology department and the TCM (traditional Chinese medicine) department. These are not necessarily cheap options, and some traditional remedies are more expensive than innovative western treatments. Excluding a key competitor would of course warp the final view of the market
• Ability and willingness to pay: In self-pay markets the patient may be the payer so affordability of the treatment may be a barrier to usage. The size and growth of the medical insurance market may also impact demand: – If insurance packages include screening, the pool of diagnosed patients may increase – If treatment is covered by insurance, more of those diagnosed would receive prescriptions – Some patients may receive a lump sum insurance payout with freedom on how to use that money – in such cases, some may prefer not to use the money for prescription medication
• Patient access programmes (PAPs): These may help those outside insurance packages access medications – for instance offering additional help for vaccinations to those in the lowest socio-economic brackets
• Medical tourism: To benefit from cheaper prices or better care, do patients prefer to travel for treatment – e.g. from Indonesia or Vietnam to Singapore? The size of the market may be either underestimated or overestimated if this factor is not taken into consideration
• Guidelines/protocols: Some markets are highly influenced by guidelines and this would need to be built in to the materials to ensure that the range of likely uptake can be modelled, and the best case isn’t underestimated

A challenge in conducting demand assessments is that sometimes respondents overstate their likely usage or willingness to try something new when participating in market research. Behavioural economics helps us explain why:

• No risk bias: there is no risk to physicians or to consumers in agreeing to prescribe or buy a new product in a market research interview
• Acquiescence response bias: There is a general tendency to answer positively when in doubt or to conform to the social norm of appearing agreeable, even when answering anonymously
• Pro-innovation and recency biases: there is a tendency to overvalue the usefulness of something new and underestimate its limitations; or for some, to favour new evidence over prior evidence
  

To address this problem we use a series of questions to understand how likely each individual is to really act in the way they’ve described. These questions can be tailored to the specific market, but generally take the form of likelihood to use, with a simple rating scale response. When hoping to understand willingness to pay, a respondent might need to pass through a series of “gates” before we accept them as a true new user or adopter. For instance, for a vaccine: likelihood to ask an HCP about the vaccine or likelihood to purchase the vaccine, if offered by the HCP.

This could be complemented with questions on analogues e.g. did you visit a doctor to ask about a previous vaccine; did you purchase it? Or questions about general beliefs – e.g. awareness of vaccines or concern about endemic diseases and the need to vaccinate.

There can be some cultural variation in the use of scales, which also needs to be taken into account. For example, physicians in Hong Kong can be more conservative in their outlook, which can make them appear less enthusiastic about new products joining a market. On the other hand, people in the Philippines and Indonesia may be more positive and express greater interest. One potential solution to overcome this may be to swap a numeric question for a pictorial scale (for instance, clouds/sun or star ratings), and so move away from the cultural variability which may appear using verbal scale questions. This will not entirely eliminate all possible cultural differences, as, for example, variation in perception of facial emotion can influence the use of smiley-face scales (as sometimes seen in Japan) and some pictorial options may not be appropriate in a medical context (e.g. rating scales using hearts for products with potential cardiac side effects). Another solution is to standardise the answers during the analysis process, so that the relative interest in each product can be more easily measured across cultures and then applied to the final uptake results.

These questions and methodologies work together to identify physicians who would prescribe or consumers who would use or purchase. Final usage and uptake numbers are then calculated based on the total sample, but setting the usage of anyone who falls at one of the gates to 0. It is not uncommon for this to result in a discount of 25-50%.