Physicians who accept industry payments more likely to order hyaluronic acid injections
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Key takeaways:
- Physicians were more likely to administer hyaluronic acid injections for osteoarthritis if they received industry payments.
- Higher payments were also associated with larger number of injections.
Physicians who receive industry payments are more likely to administer hyaluronic acid injections, as well as an increased volume of injections, for osteoarthritis despite questionable benefit, according to data.
“Pharmaceutical industry marketing payments have been associated with greater brand-name drug use, but whether payments are associated with procedural use remains unclear,” Nishant Uppal, MD, MBA, of Brigham and Women’s Hospital and Harvard Medical School, in Boston, and colleagues wrote in a research letter published in JAMA Internal Medicine.
“Intra-articular hyaluronic acid is approved for treatment of knee osteoarthritis, although meta-analyses have found a lack of benefit,” they added. “Guidelines recommend against routine use of hyaluronic acid, yet Medicare spending on hyaluronic acid exceeded $440 million in 2019.”
To investigate the association between industry payments to physicians and the administration of hyaluronic acid to Medicare patients with OA, Uppal and colleagues conducted a cross-sectional study using information from the 2019 Open Payments Program database, as well as the 2019 Physician and Other Supplier Public Use File. Physicians who performed 50 or more large joint injections, as covered under Medicare Part B fee-for-service, were included in the study.
For the purposes of the analysis, industry payments to physicians were categorized into one of a few groups, including no payment, $1 to $100, and greater than $100. The primary outcome was the administration by physicians of any hyaluronic acid injection. The secondary outcome was the annual number of injections given.
The analysis included 20,501 physicians, of whom 41.5% reported administering hyaluronic acid injections. In all, 28.8% of included physicians reported receiving industry payments totaling $840,744, or an mean of $142.50 per doctor, in 2019.
According to the researchers, industry payments were associated with a higher likelihood of physicians administering hyaluronic acid injections. This was true for payments between $1 and $100 (aOR = 2.06; 95% CI, 1.91-2.22) and for payments greater than $100 (aOR =3.28; 95% CI, 2.7-3.98), representing 12.7% (95% CI, 11.4% to 14.1%) and 21% (95% CI, 17.6% to 24.4%) increases in probability, respectively.
In addition, industry payments were associated with a higher number of average administered injections, with IRRs of 1.56 (95% CI, 1.45-1.68) for payments between $1 and $100, and 2.15 (95% CI, 1.92-2.41) for payments above $100.
“These results suggest industry payments are associated with increased use of an invasive, high-cost procedure widely considered to have little benefit, which is discouraged by orthopedics and rheumatology guidelines,” Uppal and colleagues wrote.
“Because hyaluronic acid injections are covered by Medicare Part B, clinicians are reimbursed based on average drug sales price plus 4.3%, which along with industry payments may encourage low-value service use,” they added. “Despite nationwide efforts to raise awareness regarding low-value care, Medicare beneficiaries remain at risk for receiving low-value services. ... Professional guidelines may be inadequate to reduce low-value care delivery, necessitating policy change through Medicare Part B reimbursement redesign and industry payment restrictions.”
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