Pharmaceutical industry sponsored meals linked to increased prescribing of promoted medications

1. In this cross-sectional analysis of Medicare data, physicians who received a sponsored meal from pharmaceutical industries were more likely to prescribe the promoted brand-name medication.

2. While the absolute increase in prescribing the promoted-drug was relatively small, the impact on prescribing patterns was additive with greater number of meals and more expensive meals associated with additive increase in prescribing promoted medications

Evidence Rating Level: 3 (Average)   

Study Rundown: Pharmaceutical industry influence over physician prescribing patterns through sponsored events, meals, lectures, and other means remains a controversial topic. While there is evidence that physicians receiving over $2000 per annum from such indirect payments have measurable effects on prescribing patterns, the majority of payments are from small benefits such as sponsored meals valued at less than $20 per meal. This study sought to evaluate the specific effects from small value (<$20) meals promoting specific medications with equivalent generic alternatives on prescribing patterns of physicians.

The results of this cross-sectional analysis, after adjusting for covariates, showed physicians that received meals with associated pharmaceutical promotion were more likely to prescribe the promoted medications. Effects were additive with regards to the frequency of meals and the cost of the meals. Although the study attempted to control for confounding variables, the study design could not derive causation, and rather served as initial data to support additional investigation. There were also no adverse events or net-cost analyses performed to determine if the influences led to poor or more expensive outcomes.

Click to read the study, published today in JAMA Internal Medicine

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In-Depth [cross-sectional study]: This study used the Medicare Part D prescriber file from 2013 to link data on filled prescriptions to Open Payments database on pharmaceutical expenses in drug promotion. Four study groups were created looking at representative brand-name medications (rosuvastatin, olmesartan, desvenlafaxine, and nebivolol) in four drug classes (statins, ACE-Is/ARBs, SSRI/SNRI, and cardiac specific beta-blockers), none of which were superior to their generic counter-parts. Low volume prescribing (<10 per year) physicians were excluded from the analysis. A total of 155 849 physicians were included in the analysis.

Adjusted analysis accounting for gender, specialty, geographic location, practice type, time since medical school graduation, median census household income, and prescribing volume demonstrated increased prescriptions of study medications after one industry-sponsored meal: rosuvastatin 1.18 (95%CI 1.17-1.18, p < 0.001), nebivolol 1.70 (95%CI 1.69-1.72, p < 0.001), olmesartain 1.52 (95%CI 1.51-1.53, p < 0.001), and desvenlafaxine 2.18 (95%CI 2.13-2.23, p < 0.001). Great cost of meals (OR 1.02 to 1.13) and greater number of meals were associated with an even greater effect on prescribing patterns for all study drugs except desvenlafaxine.

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