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First Author: Colette Dejong, BA (1).
Additional Authors: Thomas Aguilar, MS (1), Chien-Wen Tseng, MD, MPH (2), Grace A. Lin, MD, MAS (1), and R. Adams Dudley, MD, MBA (1).
1. University of California, San Francisco.
2. University of Hawaii.
Background: In 2009, 84% of American physicians reported receiving meals, gifts, or payments from the pharmaceutical industry. Although industry-sponsored meals and honoraria may create opportunities for physicians to discuss new therapies, past studies using self-reported data have raised concerns about their potential to influence prescribing behavior. We used recently released data from the U.S. Sunshine Act to conduct the first national, physician-level analysis of the association between industry-sponsored meals and honoraria and physician prescribing patterns.
Methods: In this retrospective cohort study, we linked U.S. Sunshine Act data with prescribing data from Medicare Part D. We identified physicians who wrote prescriptions in any of four drug classes: selective serotonin and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs), ß-blockers, angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers (ACEis and ARBs), and statins. We identified the most-prescribed branded drug in each class (desvenlafaxine, nebivolol, olmesartan, and rosuvastatin, respectively), and used Sunshine Act data to flag physicians who received meals or payments for that drug from August-December 2013. Multivariate logistic regression was used to compare prescribing rates of each drug relative to alternatives, among physicians who received meals or payments and physicians who did not. Sensitivity analyses were conducted using propensity-score matching. We excluded research-related and royalty payments, and adjusted for physician-level demographic characteristics, specialty, and practice setting.
Results: 279,669 sample physicians received 63,524 payments associated with the four drugs, totaling $1.4 million. Sponsored meals constituted 95% of target payments, and averaged under $20. Physicians receiving one sponsored meal for the drug of interest had significantly higher rates of prescribing desvenlafaxine over other SSRIs or SNRIs (odds ratio 2.18, 95% confidence interval 2.13 to 2.23), nebivolol over other ß-blockers (1.70, 95% CI 1.69 to 1.72), olmesartan over other ACEis or ARBs (1.52, 95% CI 1.51 to 1.53), and rosuvastatin over other statins (1.18, 95% CI 1.17 to 1.18). The association was dose-dependent, with additional meals and costlier meals associated with greater increases in relative prescribing rates (p<0.001). Results were similarly significant in propensity-matched cohorts. Physicians receiving honoraria, which averaged $1,065, were significantly more likely to prescribe the targeted drug over alternatives (odds ratios of 1.20 to 2.03 across the four drugs studied, p<0.001)
Conclusions: Sponsored meals or honoraria from a drug’s manufacturer are associated with increased prescribing of that drug relative to alternatives. Further investigation of physician-industry relationships is needed to determine their potential impact—positive or negative—on healthcare costs and patient outcomes.
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