IMPORTANCE The association between industry payments to physicians and prescribing rates of the brand-name medications that are being promoted is controversial. In the United States, industry payment data and Medicare prescribing records recently became publicly available. OBJECTIVE To study the association between physicians' receipt of industry-sponsored meals, which account for roughly 80% of the total number of industry payments, and rates of prescribing the promoted drug to Medicare beneficiaries. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analysis of industry payment data from the federal Open Payments Program for August 1 through December 31, 2013, and prescribing data for individual physicians from Medicare Part D, for all of 2013. Participants were physicians who wrote Medicare prescriptions in any of 4 drug classes: statins, cardioselective β-blockers, angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers (ACE inhibitors and ARBs), and selective serotonin and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs). We identified physicians who received industry-sponsored meals promoting the most-prescribed brand-name drug in each class (rosuvastatin, nebivolol, olmesartan, and desvenlafaxine, respectively). Data analysis was performed from August 20, 2015, to December 15, 2015. EXPOSURES Receipt of an industry-sponsored meal promoting the drug of interest. MAIN OUTCOMES AND MEASURES Prescribing rates of promoted drugs compared with alternatives in the same class, after adjustment for physician prescribing volume, demographic characteristics, specialty, and practice setting. RESULTS A total of 279 669 physicians received 63 524 payments associated with the 4 target drugs. Ninety-five percent of payments were meals, with a mean value of less than $20. Rosuvastatin represented 8.8% (SD, 9.9%) of statin prescriptions; nebivolol represented 3.3% (7.4%) of cardioselective β-blocker prescriptions; olmesartan represented 1.6% (3.9%) of ACE inhibitor and ARB prescriptions; and desvenlafaxine represented 0.6% (2.6%) of SSRI and SNRI prescriptions. Physicians who received a single meal promoting the drug of interest had higher rates of prescribing rosuvastatin over other statins (odds ratio [OR], 1.18; 95% CI, 1.17-1.18), nebivolol over other β-blockers (OR, 1.70; 95% CI, 1.69-1.72), olmesartan over other ACE inhibitors and ARBs (OR, 1.52; 95% CI, 1.51-1.53), and desvenlafaxine over other SSRIs and SNRIs (OR, 2.18; 95% CI, 2.13-2.23). Receipt of additional meals and receipt of meals costing more than $20 were associated with higher relative prescribing rates. CONCLUSIONS AND RELEVANCE Receipt of industry-sponsored meals was associated with an increased rate of prescribing the brand-name medication that was being promoted. The findings represent an association, not a cause-and-effect relationship.

In the context of premium exemptions, association of health insurance with use of maternal health services, and quality of services received, depends on place where pregnant women seek ANC.

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Methods: We searched 14 electronic databases including PubMed, Embase and Cochrane Library, for all relevant articles published up to June 2014. The search strategy consisted of freetext and MeSH terms related to economic evaluation, CVD, DM and South Asia. Two independent reviewers assessed the eligibility and methodological quality of studies using the Drummond and modeling checklist, and extracted cost-effectiveness ratios (CERs). Results: Of the 2446 identified studies, 26 met full inclusion criteria. Together, these studies gave 253 independent CERs in eleven categories of interventions (singly or in combination) to control CVD and DM. Nearly half of the studies (n¼14) were based on decision modeling, and six studies each were alongside randomized trials and observational studies. Majority of studies were reported from India (n¼12), or for South Asian region taking India as an example (n¼9), followed by Bangladesh (n¼3), and Pakistan (n¼2). There were no studies published from other South Asian countries. Most interventions show significant positive economic evidence (i.e. cost-effective), when compared to the counterfactual of no intervention (Table 1). While, primary prevention strategies were largely evaluated in decision modeling studies, pharmaceutical interventions were the predominant focus in economic evaluations alongside randomized trials. Critical appraisal of economic evaluation methods revealed: 13 excellent, 6 good, and 7 poor quality studies. Significant heterogeneity in outcome measures and methodologies used in the included studies restricted a direct ranking of the interventions by their degree of cost-effectiveness.