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For most of us a fungal infection doesn't sound like a big deal. But for the critically ill, it can take a life in a matter of days.

AmBisome can save lives, but it often needs to be initiated before there’s a clear diagnosis. With decisions shrouded in doubt and uncertainty, Doctors have to act on their suspicions, using experience and intuition to fight an invasive killer.

Our task was to force consideration of AmBisome in patients where there is a high level of suspicion of an Invasive Fungal Infection. The AmBisome eDetailer was designed to bridge the gap between AmBisome’s benefits and the uncertainty surrounding decision making. The key was to present AmBisome in the context of how physicians actually make decisions, under the pressures of time and uncertainty.

The invasive fungal infection is brought to life in a virtual simulation allowing physicians work through a case as they would in the real situation, reviewing evidence, ordering tests and investigations. In time the diagnosis becomes more certain, but puts at risk the likelihood of a positive outcome upon intervention. The result is a highlighted need for early treatment and showcasing AmBisome as the treatment of choice.

Infectious Disease Physicians and Haematologists have a deep understanding of IFIs. However their approach is governed by past experience. While this is important, often the specific case information needs to be taken into account to deviate from engrained process. To highlight the importance of initiating AmBisome early, we needed to build a bridge between AmBisome’s benefits and the uncertainty surrounding decision-making. The objective was to generate discussion with specialists, particularly regarding the discrepancies of treatment initiation timing between specialists for exactly the same patient. This would enable Gilead Representatives to have more meaningful discussions with their customers.

Results have been calculated using unit data on an MAT basis across two periods:

Period 1 - prior to the app being in market.

Period 2 - whilst the app was in market.

Across the two periods the market was declining at 5% per annum.

During period 1, AmBisome declined by 13%.

During period 2, AmBisome grew by 11%.

The app, based on a virtual patient simulation, made a dramatic shift in physicians engagement with AmBisome and its unique benefits.

By changing the dynamic and driving physicians to reassess their treatment behaviours, we helped to reverse a significant business decline, in the face of a shrinking market, and put AmBisome into strong positive growth.

Stage-by-stage a patient case is played out, showing clinical deterioration, symptomatology, results of investigations (X-rays, CT scans, blood cultures, cytogenetics), and ongoing leukaemia treatment. It challenges physicians to quantify their degree of IFI suspicion and at what point they would initiate treatment. They can review actual radiograph images and examine in detail, look at real blood tests and review clinical guidelines. Response is recorded, benchmarking physicians against their peers, allowing them to see, perhaps for the first time, how their choices compare. Sales Representatives can show a physician:

1. how their intervention timing compared with others, presenting this in the context of AmBisome’s efficacy when used early

2. how their selection of causative organism compares, presenting this in the context of AmBisome’s broad spectrum activity

As an involving representation of real situations it can be used as a group-learning platform as well as a detailing tool to individual doctors.

Please refer to the 'confidential information' section of the submission for results.

Present AmBisome in the context of how physicians actually make decisions.

Under the pressures of time and uncertainty.

By bringing an invasive fungal infection to life in a virtual simulation.

This was achieved via a digital learning platform in the form of a highly interactive iPad application.

Loaded with a real patient data the case study based application investigates and learns about the trade off between certainty and safety that plays out in the physician’s head each time they are confronted with a case of suspected IFI.

The physician works through the simulation, against the clock, as they would in a real case. Reviewing evidence, ‘ordering’ tests & investigations.

Diagnosis becomes more certain with time, however the trade off is the likelihood of a positive outcome upon intervention.

Highlighting the imperative for early treatment and showcasing AmBisome as the treatment of choice.

Leukaemia patients are at high risk for invasive fungal infections (IFIs) as their immunity is severely compromised. An IFI rapidly leads to critical illness and death. These patients are further predisposed to IFIs when they receive chemotherapy or undergo immunosuppressive therapy. IFIs can be successfully treated, however early initiation is critical. Chance of success decreases rapidly for each day (or hour) that therapy is delayed. AmBisome is the gold-standard with broad-spectrum efficacy. It's also the most expensive. Because of this, physicians reserve AmBisome until there is high level of IFI suspicion, by definition, a time when AmBisome is less effective.