The concept of pharmaceutical promotion targeted at the public has been controversial throughout history for many clinicians, patients, and policymakers and has led to many regulatory changes for pharmaceutical promotion in the United States. The objective of this narrative review was to identify, assess, and summarize evidence addressing the potential impact of direct-to-consumer advertising (DTCA) on patient care through the lens of the quadruple aim of health care: (a) patient experience;(b) population health; (c) cost; and (d) provider experience. Increased spending on DTCA has frequently been cited in a negative context when discussing health policy due to inappropriate prescribing or increased spending on pharmaceuticals, but the research identified in this review describes a more complicated relationship. Any conclusions regarding the total impact on the health system will be greatly influenced by the perspective (eg, patient, provider, payer, society) of the person evaluating. In any case, benefits and harms of DTCA must be weighed in the context of the therapeutic area, population characteristics, and overall goal of the evaluator.
Cost-of-illness (COI) studies attempt to measure and describe the costs associated or attributed to a specific disease, but there are several considerations for measuring and interpreting drug costs estimates. The complexity of the pharmaceutical supply chain and contractual relationships between manufacturers, wholesalers, pharmacies and payers create challenges for researchers attempting to include drug costs in COI analyses. This article aims to provide contextual information for a general audience interested in conducting or evaluating COI studies that may include drug costs and to describe key factors to consider when reviewing drug costs in the peer-reviewed literature.
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