Key Topic 3: Comparison with competitors
From a commercial perspective it is often desirable in materials for health professionals to show an advantage for your product over its competitors. Such comparisons must be fair and capable of substantiation.
A useful tip when reviewing such comparisons is to imagine you work on the competitor product – would you consider the comparison and claims being made to be fair in this case?
Consider the following examples
Example 1
In the UK Bayer complained about a Levosert leavepiece issued by Actavis UK.
Bayer marketed Mirena. Both Levosert and Mirena were intrauterine delivery systems (IUSs) each containing 52mg levonorgestrel; both were indicated as long acting, reversible contraceptives and of particular use in women with heavy menstrual bleeding who required contraception. Levosert was effective for 3 years and then should be removed; Mirena was effective for 5 years and then should be removed. Mirena was additionally indicated for protection from endometrial hyperplasia during oestrogen replacement therapy and was effective in that regard for 4 years after which it should be removed.
The title of the leavepiece: ‘Can a single IUS be suitable for so many women?’
Bayer alleged that this claim implied that Levosert was suitable for the majority of women/more women than other IUSs. Bayer noted that Levosert had a more limited licence than Mirena, with fewer indications and a shorter licensed duration of use, limiting its suitability for some women.
Bayer further alleged that another claim
‘Levosert is available at a low acquisition cost. 25% saving compared to Mirena’
was inaccurate and misleading. Levosert could not be compared with other IUSs and that the comparison with Mirena in particular could mislead by placing undue emphasis on the acquisition cost saving, without clearly stating that it had different licensed indications and duration of use. It was not a like-for-like comparison. For five years Mirena cost less per year than Levosert.
Do you agree or disagree with Bayer?
Ruling
Overall the Panel considered that the first claim implied that Levosert had a broader use than other IUSs which was not so. In the Panel’s view the claim was misleading, could not be substantiated and did not encourage the rational use of Levosert.
The Panel considered that the second claim implied that the cost of contraception with Levosert would always be 25% less than with Mirena, which was not so. In the Panel’s view the claim did not provide enough information for the prescriber to make a well informed decision.
Example 2
Novartis complained that an Arimidex (anastrozole) mailing issued by AstraZeneca in the UK presented an oversimplified and misleading cost comparison which failed to compare like with like in terms of the indications. The mailer compared the prices of 28 days treatment with the aromatase inhibitors anastrozole, letrozole and exemestane. The licensed indications for all the products were not given on the mailing, but at the time the indications were as follows:
The mailing had been sent to hospital and network pharmacists and included the costs of 28 days’ treatment with Arimidex (£68.56), letrozole (£83.16) and exemestane (£82.88) beneath the heading ‘Comparing the cost of Aromatase Inhibitors in the treatment of breast cancer’.
Which of the following do you agree with?
- The agents are all in the same class and 28 days treatment is compared so this is a fair comparison
- The indications are different so this is not a fair comparison the Panel stated that Arimidex would not be the cheapest option for all types of breast cancer due to the different indications
- If the piece did not state that the licensed indications were different this was misleading
- The three products did share one common indication so this is a fair comparison
Ruling
The Panel noted that the indications for the products differed. When Arimidex was used in accordance with its licence it would be less expensive than the other products listed when they were also so licensed. However the cost comparison appeared beneath a general heading relating to the treatment of breast cancer. There was no information stating that the indications differed so this comparison was seen as misleading and unfair.
