Industry payments to physicians spur use of low-value drugs for patients with cancer
Click Here to Manage Email Alerts
Key takeaways:
- Researchers found payments from industry associated with lower use of branded drugs.
- Industry influence has the potential to negatively impact patient care.
Researchers identified an association between industry payments to physicians and nonrecommended and low-value drugs in certain clinical scenarios, according to study results published in The BMJ.
The findings raise quality-of-care concerns about financial relationships between physicians and industry, researchers concluded.
Rationale and methodology
“Financial relationships between U.S. physicians and the pharmaceutical industry are common,” Aaron P. Mitchell, MD, MPH, researcher in the department of epidemiology and biostatistics at Memorial Sloan Kettering Cancer Center, and colleagues wrote. “These payments comprise both cash and in-kind gifts, and most commonly represent free meals, travel and lodging, and speaker and consulting fees. Payments from industry have long raised concerns about medical professionalism and the independence of physician decision making.”
Investigators sought to assess the association between oncologists’ receipt of payments from the pharmaceutical industry and delivery of nonrecommended or low-value interventions to patients.
The cohort study included Medicare beneficiaries diagnosed with incident cancer between 2014 and 2019. All patients met inclusion criteria for being at risk for one of four nonrecommended or low-value interventions, including denosumab (Prolia/Xgeva, Amgen) for castration sensitive prostate cancer, granulocyte colony stimulating factors (GCSFs) for patients at low risk for neutropenic fever, nab-paclitaxel for cancers with no evidence of superiority over paclitaxel and a branded drug in settings where a generic or biosimilar version was available.
Patient receipt of a nonrecommended or low-value drug served as the study’s main outcome measurement; the primary association of interest included the assigned oncologist’s receipt of any general payments from the manufacturer of the corresponding nonrecommended or low value drug within 365 days before the patient’s index cancer date.
Findings
Results showed that oncologists received industry payments for 30.2% of patients at risk for nonrecommended denosumab (median $63), for 28.3% of patients at risk for GCSF (median $60), for 21.4% of patients at risk for nab-paclitaxel (median $89) and 31.2% of patients at risk for branded drugs (median $156).
Researchers additionally found an unadjusted proportion of patients who received nonrecommended denosumab of 31.4% among those whose oncologist didn’t receive payment and 49.5% of patients whose oncologist did receive payment, for a prevalence difference of 18%.
Results showed corresponding values for GCSF (26.6% vs. 32.1%; prevalence difference, 5.5%), nab-paclitaxel (7.3% vs. 15.1%; prevalence difference, 7.8%), and for branded drugs (88.3% vs. 83.5%; prevalence difference, 4.8%).
After researchers controlled for patients’ characteristics and calendar year, they found that payments from industry had an association with increased use of denosumab (17.5%; 95% CI, 15.3-19.7), GCSF (5.8%; 95% CI, 5.4-6.1) and nab-paclitaxel (7.6%; 95% CI, 7.1-8.1), but lower use of branded drugs (4.6%; 95% CI, 5.8 to 3.3).
Moreover, results of physician-level indicator models showed an association between payments from industry and increased use of denosumab (7.4%; 95% CI, 2.5-12.2) and nab-paclitaxel (1.7%; 95% CI, 0.9-2.5), but not with GCSF (0.4%; 95% CI, 0.3 to 1.1) or branded drugs (1.2%; 95% CI, 6 to 8.5).
Researchers multiple study limitations, including the observational, claims-based design. In addition, physician attribution using claims is an imperfect approach and there is a possibility of misidentifying the physician responsible for the decision about treatment, they added.
Future research
The findings suggest that industry influence has the potential to negatively impact the care of patients, researchers wrote.
“Patients with cancer whose oncologist received payments from industry appeared more likely to receive nonrecommended and low-value treatments,” they wrote. “This study focused on a narrow group of patients and interventions, and further research is needed to better characterize whether, and to what degree, the observed association between payments and poorer care quality extends to other settings. Given the potential concerns for care quality raised by this study, however, it may be appropriate to re-examine the current status of personal payments from the drug industry to physicians.”
Collapse
Click Here to Manage Email Alerts