The Online Channel: A Lower Cost Per Clinical Trial Patient Acquisition

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Clinical Trial Performance Results:

• Migraine study – 400 referrals in 28 days
• Diabetes 2 study – 300 visitors to pre – screener, 100 referrals in 3 days
• Highly specialized diabetic ailment – 125 referrals in 30 days
• ADD/ADHD – 400 referrals in 45 days
• Migraine study open for six months – 9501 migraine sufferers from participating sites to the client’s online screener

Boomerang Pharmaceutical Communications, www.boomerangpharma.com, a consumer based Internet advertising agency, delivers a lower cost means to recruit patients for clinical trials. In just two weeks, Boomerang can set up a study specific website screener to reach patients and caregivers 24 hours a day, seven days a week.

The initial investment to the trial team is typically what the industry pays on average to recruit three patients into a Phase III trial. With the pharmaceutical industry estimating the average cost per Phase III patient recruited at $7,635, Internet savvy agencies are jumping in to find patients.

Today, more than 85 percent of U.S. patients’ research their medical conditions on the Internet, creating an accessible and motivated pool of potential trial study participants. Boomerang captures them at that exact moment, when they are motivated to act on their condition, and strives to get them to the investigator within 72 hours. The power of Internet targeting, the extremely high volume of visitors, the confidentiality of the web, the flexibility, and ability to give out trial information, lead to a more simple and gratifying approach.

Boomerang is unique in the patient recruitment arena in that they start by supplying an inexpensive website screener. When compared to the budget needed to staff a call center, create TV commercials, radio ads, or direct mail, this is truly a bargain. The website design incorporates ten years of best practices experience, and is positioned at consumers, not medical professionals. With a few simple mouse clicks, both parties know if the trial and potential patient are a good fit.

The website design should not be confused with those provided by ClinicalTrials.gov, Cancer.gov, Centerwatch.com, or the many provided by major Pharmaceutical companies. The content on those sites is confusing and frustrating for non-medical professionals to understand. Without the help of a health care provider, patients have no idea of whether or not they are eligible for trial participation. Furthermore, the average consumer has never even heard of those websites, as they are not advertised.

Launching a consumer recruitment website is just the beginning. The big challenge is to drive qualified patients to it, at a reasonable cost. This is where online expertise separates a certified expert from other traditional recruitment agencies. Performance metrics should be provided before the campaign, estimating a final cost for patient acquisition. Each advertised keyword should be analyzed to be sure that it is providing optimal results, leading back to patient randomizations.

How Search Engine Marketing Campaigns Work
Many search engines accept bids for certain keywords or keyword phrases. When a user enters this keyword phrase, an advertiser’s link, either in the form of a separate advertisement or a sponsored link, is displayed in a prominent position. In the case where two or more advertisers want to bid on the same keyword phrases, the higher bid will receive prominent positioning.

The links (at the top), and links in the right-hand column are sponsored listings, i.e. an advertiser has paid for these links to appear. The order in which the links appear depend on the amount the advertisers have bid for this keyword phrase; the higher the bid, the higher the position.

The bid amount is paid to the Search Engine (Yahoo, Google, MSN) each time a user clicks on the link.

Copywriters will create the initial text advertisements that appear when the chosen search terms are entered. The media company will submit the keywords and advertisement text to the media publishers for approval. Both Google and Yahoo have a number of rules about what can and can't appear in the text. For example, the text must be related to the keywords used, and the website or service advertised must be related to the keywords and advertisements.

Once the campaign begins, the sponsor must continually monitor the performance of each keyword and adjust the bids to maximize the visitor conversion rate and cost per click. In addition, the ads will be tracked to ascertain which ones are performing better, in terms of generating clicks and soft conversions, opt-ins of qualified patients for the study.

In addition to cost per click campaigning on Google and Yahoo, Boomerang targets patients who are already participating in a permission-based survey system, receptive to e-mail communication and who suffer from specific aliments. This generates a million more possibilities of finding participants per month. There are also banner ad placements to reach millions more.

Therapeutic Area Targeting
Even with a best in class patient recruitment screener, some therapeutic areas remain challenging. The Internet works best where consumers can determine their own eligibility. If the inclusion criteria are simple, such as recurrent prostate cancer, or first line lung cancer, you will have much more success. If the protocol requires a patient to understand their tumors’ particular pathology, like in oncology, the system is not successful yet.

Some areas that can work great include:

• Central nervous system disorders: Depression, Bi-polar, ADHD, Migraine sufferers, or General Anxiety Disorder.
• Gastro-intestinal disorders: GERD, Dyspepsia, Irritable Bowel Syndrome, and Constipation.
• Dermatology related disorders: Cosmetic procedures, Ringworm, Toenail Fungus, Eczema, Acne.
• Anything where there is pain associated with the condition. These patients are online looking for answers and are motivated to try new avenues for relief.
• Rare disorders: This is where the targeting of the Internet pays off. A patient diagnosed with something that they have never heard of always goes to the Internet for more information.
• High cholesterol disorders and diseases where there are few acceptable treatment options.
• Pediatric indications: Mothers are online in droves, looking for answers.

Boomerang does offer complete recruitment; incorporating traditional direct mail, radio TV, patient retention and site support. In addition, Boomerang has a unique relationship with active 55+ year-old senior centers to conduct live screening events and targeted promotions to one million monthly participants.

In addition to campaigning in the US, Boomerang has conducted some initial campaigns in Europe during 2007. Although it is more challenging, due to DTP regulatory constraints, with local resources working to insure IRB approvals, it can be done. Boomerang’s Headquarters is based in Mulhouse, France, so giving them global access and experience.

Questions you should ask your patient recruitment agency before using them to conduct an online campaign

1. Do you have your own IT capabilities in-house?
   The agency chosen should build websites as a core business, and be familiar with the back-end requirements for getting this work done.
2. Where is the online patient screener hosted? Is it secure? Has it been validated by a third party for compliance?
   Security is an important concern and online screening should be conducted on a secure hosting environment. It must comply with HTTPS protocol with keys and certificates to guarantee the confidentiality between the user and the eRecruitment platform.
3. Are you using HTTPS to insure that any personal patient data has been encrypted? Are you using two separate databases?
   Separating and encrypting the personal data and health data in a database within the eRecruitment platform using keys and certificates insures that all patient privacy rules will be followed. There is anonymous access by an administrator to user information using Fax ID #s when necessary
4. Are you a Google Certified professional agency?
   There are several designations pertaining to training, excellence and ethics when conducting an online campaign. These include, Google Certified Agency by Google. Search Engine Marketing Professional Organization – SEMPO.
5. Do you have direct access to consultants from Google, Yahoo and MSN Search Networks?
   Because we work on cost per click campaigns everyday, the major search engines provide us with a dedicated account team to advise us on latest trends, new offerings and important advice.
6. What program are you using for optimizing your cost per click advertising campaigns? What web-based metrics will you be providing? Are you measuring any additional conversion metrics?
   Online campaigning is relatively new, and few patient recruitment agencies have experience in managing spending in this arena. As the cost of online media continues to escalate, it is imperative that the online agency optimizes spend via campaign specific software tools. These should be reported to you weekly in an easy to understand format, relating cost per click to cost per recruited patient.
7. How many online patient recruitment campaigns have you completed? What was the best result you ever had? What was the worst?
   If they do not admit to some failures, they have not been at this very long. These mistakes should serve to teach some valuable lessons. There should be enough confidence in the expected result, as evidenced by a risk-share.
8. What will be the approximate cost per recruited patient for this campaign?
   Using historical metrics, an experienced vendor should be able to provide you with an estimated cost per qualified referral for your campaign. This is a formula based on the inclusion / exclusion criteria, investigator list (or # of sites), and campaign length.
9. What are the key components for creating a highly usable website?
   Even a 15 year old can build a website. The question is, will it convert visitors to trial participants? The website should be simple, straightforward and drive patients directly into the online screener, so that their qualifications can be assessed. The number of questions should be kept to a minimum, so that patients do not lose interest. If patients are asked questions that they cannot understand, they will discontinue.
10. When should you consider a national vs. local media campaign?
    Local market campaigning is available with both Google and Yahoo, as will as with email programs. This minimizes the costs of wasted ad spend on patients who are not close to any investigators. Historically, if there are more than 25 investigators, it pays to use a national campaign.
11. Can you provide weekly reporting on the campaign key metrics? Can these be easily integrated into the project related metrics?
    Metrics should drive decision-making for every dollar spent. If the campaign isn’t working, you can cancel a campaign at any time.
12. Can you have the website up and running, and be ready to launch the project in just two weeks?
    Trial teams often only consider patient recruitment in rescue mode. When that happens, you need to act fast to get more patients in, to meet your deadlines. We have developed a streamlined project plan, including IRB friendly web pages, for fast legal and regulatory approval.
13. Are you willing to risk share?
    A good recruitment vendor will welcome the opportunity to risk-share in a performance based metrics system.