Association between industry payments for opioid products and physicians’ prescription of opioids: observational study with propensity-score matching

Abstract

BackgroundIndustry marketing to physicians for opioids has received substantial attention as it can potentially influence physicians’ prescription of opioids. However, robust evidence demonstrating a causal link between industry payments for opioids and physicians’ prescription practice for opioids is lacking.MethodsUsing the national databases of physicians treating Medicare beneficiaries, we examined the association between physicians’ receipt of opioid-related industry payments in 2016 and (1) the number of opioids prescribed and (2) the annual expenditures for the opioid products by those physicians in 2017, using propensity-score matching in a 1:1 ratio adjusting for the physician characteristics (sex, years in practice, medical school attended, specialty), the number of opioid prescriptions in 2016, and physicians’ financial relationships with industry in 2015. We compared matched pairs of physicians using the estimated effect and paired t-test.ResultsAmong 43 778 physicians included after propensity-score matching, physicians who received opioid-related industry payments in 2016 prescribed more opioids (153.8 vs 129.7; adjusted difference (95% CI), 24.1 (19.1 to 29.1)) and accounted for more spending due to opioids ($10 476 vs $6983; adjusted difference (95% CI), $3493 (2854 to 4134)) in 2017, compared with physicians who did not receive payments. The association was larger among primary care physicians than surgeons or specialists. The dose–response analysis revealed that even a small amount of industry payments was sufficient to effectively affect physicians’ prescription practice of opioids.ConclusionsOpioid-related industry payments to physicians in the prior year were associated with a higher number of opioid prescriptions and expenditures for opioid products in the subsequent year.

Association between industry payments and prescriptions of long-acting insulin: An observational study with propensity score matching

“…In this context, our findings focusing on long-acting insulin (which constitutes a large proportion of insulin prescriptions and expenditures in the US [20]) generate a hypothesis that physician-industry financial relationship may increase the overall costs of long-acting insulin for patients with diabetes, which works against the national effort to reduce the patients' financial burden of using insulin. Although our data do not adjudicate the appropriateness of the prescription, it may also be possible that industry marketing payments introduce physicians' preference of prescribing long-acting insulin rather than cheaper, oral antihyperglycemic therapies that may be equally effective in some clinical situations, given the prior literature on this topic [4][5][6][7]. More investigations are warranted for long-acting insulins to avoid unnecessary prescriptions of this costly and common drugs that affect millions of Americans with diabetes.…”

“…As a part of the Affordable Care Act, since 2013, the Open Payments program has mandated that medical product manufacturers publicly report all payments to physicians and teaching hospitals [ 3 ]. Previous studies have documented associations between industry payments and prescriptions for specific drugs including opioids [ 4 , 5 ] and cardiovascular drugs [ 6 , 7 ]. Some studies also showed that even the receipt of meals—the most frequent and inexpensive type of industry payments [ 8 ]—was associated with an increased rate of prescriptions of drugs from the sponsoring manufacturer [ 7 ].…”

Bias amplification in the g-computation algorithm for time-varying treatments: a case study of industry payments and prescription of opioid products

“…The financial relationship between physicians and the pharmaceutical industry has received substantial attention as it may affect physicians’ clinical practice [ 14 , 15 ]. Since the launch of the Open Payments program under the Physician Payment Sunshine Act which requires the pharmaceutical industry to publicly report data on all payments and ownership interests made to licensed physicians and teaching hospitals in 2013 [ 16 ], a growing body of literature linking the financial physician-industry relationship with physicians’ prescriptions of opioids has been published [ 17 – 21 ]. All previous studies consistently showed the association between the receipt (or the number of encounters) of industry marketing payments at a single time point and an increased number of opioid prescriptions.…”

Awareness and Perceptions among Members of a Japanese Cancer Patient Advocacy Group Concerning the Financial Relationships between the Pharmaceutical Industry and Physicians

“…Additionally, several studies revealed that junior physicians, more so than senior physicians, were more likely to accept interactions with Pharma [ 85 , 86 ] and consider them appropriate and valuable [ 86 ]. Therefore, we would suggest that all medical schools establish a curriculum on FCOI addressing these relationships’ undue influence on clinical practice [ 6 , 69 , 87 ] and their impact on patient trust and care [ 73 ]. Given that even preclinical medical students can interact with Pharma, it might be advisable to implement this curriculum early, by the second or third year in Japan [ 77 , 88 , 89 ].…”