CLINICAL NEWS
Study Finds Pharmaceutical Funding Influences
Selection of Cancer Treatment
U.S. physicians and hospitals receive approxi-
mately $7 billion annually from the pharma-
ceutical industry. According to a research
letter published in JAMA Internal Medicine,
this type of funding can sway cancer special-
ists’ prescribing patterns.
In a review of data from the Centers for Medi-
care & Medicaid Services (CMS) Open Payments
system and the Medicare Part D program from
2013 and 2014, Aaron P. Mitchell, MD, from the
Division of Hematology/Oncology at the Univer-
sity of North Carolina School of Medicine, and
co-authors found that the likelihood of an oncolo-
gist prescribing a manufacturer’s anti-cancer drug
increased if he or she received payments from the
manufacturer – even when there were other treat-
ment options available.
The investigators selected six on-patent,
anti-cancer drugs that were recommended by
the National Comprehensive Cancer Network
and were prescribed by at least 10 physicians
in 2014: sorafenib, sunitinib malate, and
pazopanib hydrochloride for metastatic renal
cell cancer (mRCC); and dasatinib, imatinib
mesylate, and nilotinib hydrochloride mono-
hydrate for chronic myeloid leukemia (CML).
They compared general payments (e.g.,
gifts, consultancy/speaker fees, meals, and
travel) and research payments (e.g., preclinical
research, U.S. Food and Drug Administration
phase I-IV trials, and investigator-initiated
studies) that oncologists received in 2013 with
their prescribing patterns in 2014.
Among the 354 physicians who prescribed
mRCC drugs in 2014, 9 percent (n=32) received
research payments and 25.1 percent (n=89)
received general payments in both 2013 and
2014. Among the 2,225 who prescribed CML
drugs in 2014, 38 received research payments
and 879 received general payments in both 2013
and 2014.
The odds of an oncologist choosing a
manufacturer’s mRCC drug nearly doubled if
he or she received any type of payment, while
the likelihood of prescribing a manufactur-
er’s CML drug rose by 31 percent ( TABLE 2 ).
TABLE 2.
Doctors who received general payments had
the highest odds of choosing the manufac-
turer’s drug, while research payments were
associated with smaller or statistically non-
significant increases.
Specifically, the researchers observed
increased prescribing for three of the six
included drugs: sunitinib (50.5% vs. 34.4%;
p=0.01), dasatinib (13.8% vs. 11.4%; p=0.02),
and nilotinib (15.4% vs. 12.5%; p=0.01).
“Decisions about
prescribing
[oncologic drugs]
should ideally be
determined by
a doctor-patient
discussion that is
free from outside
influences.”
—STACIE B. DUSETZINA, PhD
There were no associated increases in
prescribing among doctors who received pay-
ments from the manufacturers of the remain-
ing drugs: sorafenib, pazopanib, or imatinib.
The similar prescribing rates among doctors
who did and did not receive payments from
imatinib’s manufacturer (72.4% vs. 75.5%;
p=0.02) “may reflect a strategy by the manu-
facturer of imatinib (which also produces
nilotinib) to promote switching to nilotinib
before the patent expiration of imatinib in
2015,” the authors noted.
The authors also analyzed payments as
a continuous variable and reported that
increased payment amounts were associated
with increased prescribing for mRCC, but
only slightly increased prescribing for CML.
The odds ratios (ORs) for payments types
were:
• General payments: 1.23 (95% CI 1.12-1.35;
p<0.001) for mRCC and 1.05 (95% CI 1.03-
1.08; p<0.001) for CML
• Research payments: 1.07 (95% CI 1.01-1.14;
p=0.03) for mRCC and 1.01 (95% CI 0.99-
1.04; p=0.24) for CML
“Because oncology is a high-risk disease area
and the drugs are very expensive, decisions
about prescribing should ideally be determined
by a doctor-patient discussion that is free from
outside influences,” corresponding author
Stacie B. Dusetzina, PhD, from Vanderbilt
University Medical Center in Nashville, said in
a press release accompanying the study.
The study is limited by its observational
design, potential inaccuracies reported in
the databases, lack of generalizability to
other cancers, and absence of information
on the indication for which these drugs were
prescribed. The small sample size – particu-
larly for oncologists receiving CML research
payments – also limited the implications of
the findings.
The corresponding authors report no finan-
cial conflicts.
REFERENCE
Mitchell AP, Winn AN, Dusetzina SB. Pharmaceutical industry payments and
oncologists’ selection of targeted cancer therapies in Medicare beneficiaries.
JAMA Intern Med. 2018 April 9. [Epub ahead of print]
Association Between Pharmaceutical Industry Payments Received in 2013 and Drug Choice in 2014
Overall Association
Metastatic Renal Cell Cancer
Chronic Myeloid Leukemia
Odds Ratio p Value Odds Ratio p Value
1 (Reference) NA 1 (Reference) NA
1.84
(95% CI 1.25-2.70) 0.002 1.31
(95% CI 1.14-1.48) <0.001
No payments in 2013 1 (Reference) NA 1 (Reference) NA
Any payments in 2013 2.05
(95% CI 1.34-3.14) 0.001 1.29
(95% CI 1.13-1.47) <0.001
No payments in 2013 1 (Reference) NA 1 (Reference) NA
Any payments in 2013 1.84
(95% CI 1.25-2.70) 0.02 1.16
(95% CI 0.89-1.53) 0.27
Any Payments
No payments (general or research) in 2013
Any payments (general and/or research) in 2013
General Payments
Research Payments
NA = not applicable
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