The relation between promotional spending on drugs and their therapeutic gain: a cohort analysis

Abstract

journal advertisements by the Canadian Pharmaceutical Advertising Advisory Board, there is no a priori reason to believe that the situation in Canada is either the same as or different from the one south of the border. This study looks at the most heavily promoted drugs and the therapeutic gain from those products. It also compares the therapeutic gain from the most-promoted drugs and the topselling drugs by dollar value. Examining whether the medicines that are heavily promoted are the ones that provide the most therapeutic gain may help in determining whether doctors should be using promotional material to inform themselves about therapeutically important drugs. Methods Sources of dataI used the annual reports from IMS|Brogan (now QuintilesIMS) as the primary source of data about the amount of money spent on journal advertisements and visits by sales representatives, and the top products by sales revenue, as this company is the only publicly available source that reports this type of information consistently from year to year. IMS|Brogan information is limited to the top 50 drugs in each of the 2 categories. IMS|Brogan sells data and reports to all the top 100 worldwide global pharmaceutical and biotechnology companies, as well as consulting firms, advertising agencies, government bodies and financial firms, 6 and has produced reports for the Canadian federal government. 7 From the reports for 2013, 2014 and 2015, 8-10 I extracted the generic name, brand name and amount spent on promotion for the 50 most heavily promoted drugs in each year. For the 50 top-selling products in each year, I recorded the generic and brand names. The list of the top 50 products includes devices for measuring blood glucose level, and these were excluded from the analysis, as were generic drugs if the brand-name drug was also on the list of top 50 products. Different formulations of the same drug were treated as unique products. Determination of therapeutic gainI determined the therapeutic gain from products from information on the website of the Patented Medicine Prices Review Board (PMPRB) (www.pmprb-cepmb.gc.ca/ pmpMedicines.asp?x=611) and the independent French drug bulletin Prescrire International (http://english.prescrire.org/ en/Search.aspx; subscription required). I chose these sources because they both provide objective assessments of therapeutic value that do not require any subjective interpretation.The PMPRB is a federal agency that is responsible for calculating the maximum introductory price for all new patented medications introduced onto the Canadian market. It is important to note that the PMPRB is not a payer, and, therefore, its decisions about therapeutic value are not influenced by how much it might have to pay for the product. As part of the process of determining the price, the PMPRB's independent Human Drug Advisory Panel determines the therapeutic value of each product it reviews; these evaluations are available on its website. The advisory panel determines the ratings for the drugs before the maximum price...

Physician characteristics, industry transfers, and pharmaceutical prescribing: Empirical evidence from medicare and the physician payment sunshine act

“…However, detailing is often a mixture of scientific evidence and promotional marketing that physicians have difficulty separating . In addition, several studies examining the therapeutic value of the most aggressively promoted drugs have indicated that these drugs are less innovative, possess little/no value over existing medications, and have generic substitutes . Furthermore, a number of studies have found evidence that transfers are associated with higher prescription costs and lower quality prescriptions implying that transfers may create an undue COI …”

“…In addition, several studies examining the therapeutic value of the most aggressively promoted drugs have indicated that these drugs are less innovative, possess little/no value over existing medications, and have generic substitutes. 7,8 Furthermore, a number of studies have found evidence that transfers are associated with higher prescription costs and lower quality prescriptions implying that transfers may create an undue COI. [9][10][11][12] Given the potential dangers associated with transfers and COI, developed guidelines for managing COIs.…”

Pharmaceutical company spending on research and development and promotion in Canada, 2013-2016: a cohort analysis

“…This orientation is reflected in a statement about the role of pharmaceutical sales representatives issued by Rx&D, the predecessor to IMC: “Provider-supported detailing generates awareness about new treatments and provides science-based and Health Canada approved advice on how to administer these medications” [ 14 ]. Previous research that examined the most heavily promoted products in Canada, showed that the vast majority of spending went to medications that offered little to no additional therapeutic value over existing therapies [ 15 ]. The comprehensiveness of the safety information provided by sales representatives when they visit doctors was investigated in a study involving primary care practitioners in Vancouver and Montreal.…”

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“…Not by chance, the published cost estimates for developing a new drug vary almost ten times from the lowest to the highest [19]. Then, aggressive marketing is still required to sell expensive medicines that often differ only marginally [18,20], with trendy 'personalized medicine' helping to create an ideal setting for price discrimination for new similar drugs [21]. Anticancer drugs can be considered an emblematic example of unsustainable prices [22].…”