Restrictions on drug detailing may lead to less prescribing
Researchers looked at changes in prescribing behavior of 2,126 physicians at 19 academic medical centers in five states before and after enactment of detailing policies and compared them with those of 24,593 matched control physicians.
Policies to regulate pharmaceutical detailing were associated with modest but significant decreases in prescribing in some but not all academic medical centers that enacted them, a study found.
Researchers compared changes in the prescribing behavior of 2,126 physicians at 19 academic medical centers in five states (California, Illinois, Massachusetts, Pennsylvania, and New York) during three-year periods before and after enactment of detailing policies with those of 24,593 matched control physicians. Monthly within-drug class market share of prescriptions written by an individual physician for 262 detailed and nondetailed drugs were compared for eight drug classes. The study was published May 2 by JAMA.
The analysis included 16,121,483 prescriptions written between January 2006 and June 2012. The sample mean market share at the physician-drug-month level for detailed and nondetailed drugs prior to enacting policies was 19.3% and 14.2%, respectively. Detailing policies were associated with a decrease in the market share of detailed drugs of 1.67 percentage points (95% CI, −2.18 to −1.18 percentage points; P<0.001) and an increase in the market share of nondetailed drugs of 0.84 percentage point (95% CI, 0.54 to 1.14 percentage points; P<0.001).
Associations were statistically significant for six of the eight studied detailed drug classes (drugs for lipid-lowering, gastroesophageal reflux disease, hypertension, insomnia, attention-deficit/hyperactivity disorder, and depression, but not for diabetes drugs or antipsychotic drugs) and for nine of the 19 centers that implemented policies.
Drugs to treat insomnia, gastroesophageal reflux disease, and attention-deficit/hyperactivity disorder all showed decreases of greater than five percentage points in market share for detailed drugs. Market share of detailed drugs for depression, hypertension, and lipid-lowering decreased by 0.84 to 2.32 percentage points. All of these results were statistically significant. Coefficients for change in market share of nondetailed attention-deficit/hyperactivity disorder drugs and detailed and nondetailed antipsychotic drugs and diabetes drugs were not statistically significant.
Eleven of the 19 academic medical centers regulated salesperson gifts to physicians, restricted salesperson access to facilities, and incorporated explicit enforcement mechanisms. For eight of these 11 centers, there was a significant change in prescribing. In contrast, there was a significant change at only one of eight centers that did not enact policies in all three areas.
The study authors wrote that reducing the prescribing of detailed drugs and increasing the prescribing of nondetailed drugs potentially represents a large reduction in costs. “In 2010, pharmaceutical companies earned more than $60 billion in revenues for detailed drugs included in the study, and generic drugs are on average 80% to 85% less expensive than brand-name drugs. A 1-percentage point change in market share could represent approximately a 5% relative change in revenue for the average detailed drug, suggesting that the observed changes in prescribing could have important economic implications.”
An editorial noted benefits (faster adoption of novel therapies) and harms (overuse and expense) from pharmaceutical detailing. Alternative educational routes exist elsewhere to educate physicians about new therapies and reduce conflicts of interest (COI), the editorial stated, but they are untested in the United States. “It has never been more important for physicians to come together to consider these alternatives, generate evidence about their effectiveness, and move the health care system toward solutions that lower costs for patients and minimize COIs,” the editorialists wrote.