Drug company payments associated with physicians’ prescribing choices for cancer drugs
June 2, 2017
Physicians paid by pharmaceutical companies for meals, talks and travel were more likely to prescribe those companies’ drugs to treat two cancer types, according to preliminary findings that will be presented June 3 at the annual meeting of the American Society of Clinical Oncology in Chicago.
Dr. Aaron Mitchell
Aaron Winn
Dr. Stacie Dusetzina
The three study investigators are researchers in the UNC Gillings School of Global Public Health – lead author Aaron Mitchell, MD, master’s student in epidemiology and fellow in hematology and oncology at the UNC School of Medicine; Stacie Dusetzina, PhD, assistant professor of health policy and management and the study’s senior author; and Aaron N. Winn, MPP, health policy and management doctoral student. Dusetzina also is assistant professor in the UNC Eshelman School of Pharmacy and member of the UNC Lineberger Comprehensive Cancer Center.
“Ideally, therapy choices should be based on two things, and two things only – medical evidence and patient preference,” Mitchell said. “As patient advocates, we should try to eliminate any barriers to this. We saw a consistent increase in prescribing of a company’s drug stemming from what we call ‘general payments,’ which don’t go directly for research but instead are paid to physicians for consulting, meals, travel and lodging for conferences or talks. This raises the possibility that drug companies are able to influence prescribing practices through gifts to physicians.”
In 2016, several research groups identified links between pharmaceutical payments and prescription practices. For example, one study found that doctors who received a single meal promoting certain brand-name drugs prescribed those drugs for depression, high cholesterol and heart disease at higher rates. A second study found a link between industry payments and higher rates of prescriptions for brand-name cholesterol drugs.
In oncology, the stakes are high, Mitchell said, as cancer drugs can have significant side effects and financial costs.
“This pattern is worrisome since promotional efforts by pharmaceutical companies tend to focus on newer products, which may steer providers and patients to more expensive treatments,” Dusetzina said. “This ultimately could drive up costs for patients and taxpayers.”
To examine whether company payments influence prescription choice in cancer care, researchers analyzed prescription patterns for Medicare patients with two cancers for which there are multiple treatment options – metastatic renal cell cancer (a type of kidney cancer) and chronic myeloid leukemia (a blood cancer).
They used publicly available data reported through Open Payments, a provision of the federal Patient Protection and Affordable Care Act, which requires United States drug and device manufacturers to disclose transfers of financial value greater than $10 to physicians and teaching hospitals.
“We chose these specific drugs because they are felt to be equally efficacious, based on clinical trials,” Mitchell said. “However, they do have differences in side-effect profiles that a patient taking one of these drugs would notice and feel.”
Compared to physicians who received no payments, those who received general payments for meals and lodging from a drug manufacturer were more likely to prescribe that company’s particular drug for both metastatic renal cell carcinoma and for chronic myeloid leukemia. For renal cell carcinoma, odds were 78 percent higher, and for chronic myeloid leukemia, odds were 29 percent higher.
The average amount physicians received in general payments was $566 for renal cell carcinoma, and $166 for chronic myeloid leukemia.
“Even for physicians who received very small payments, we still saw a change in prescription rates,” Mitchell said. “It looks like this [is] a really good buy for a drug company.”
Meanwhile, they did not find a consistent relationship for physicians who received payments from pharmaceutical companies solely for research. This does not rule out the possibility of an association, however, Mitchell said.
He called for more research to explore the impact of research payments on prescription practices, and to uncover whether the association they found between general payments and prescription choice was a cause-and-effect relationship.
“This is a ‘proof of principle’ study, showing that there is an association between industry payments and prescribing in cancer care, and that this may also be present for other treatment choices where the options are not equivalent,” Mitchell said. “If evidence emerges to show that drug industry payments are not only associated with changes in physician practice, but cause these changes, then we need to find some solution to prevent physician-industry relationships from influencing physicians in such a manner.”
The study was supported by a National Research Service Award Postdoctoral Traineeship from the Agency for Healthcare Research and Quality with the UNC Cecil G. Sheps Center for Health Services Research and the American Cancer Society.
A version of this article first appeared on the UNC Lineberger website.
Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu
