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An Outlier in Pharmaceutical Advertising

Direct to consumer advertising works, but does it mean that utilization is appropriate? (Volume 10, Issue 7)

Among the community of nations, the United States often stands as an outlier. It numbers among the three countries without the metric system and now finds itself in a similarly small group in rejecting the Paris Agreement on climate change.

Kate Russell (Flickr/CC)

When it comes to allowing direct-to-consumer advertising (DTCA) of pharmaceuticals, however, the United States finds itself in even sparser company, along with only New Zealand. Unsurprisingly, DTCA is controversial, with proponents arguing for its ability to increase patient engagement with health topics, while opponents fear that it misleads consumers and causes over-utilization. This study brings more evidence into that debate by investigating how DTCA for statins in the 75 largest designated market areas in the United States affects statin use.

The main finding was an association between DTCA and an increase in sales and dispensing of statins. Why does this matter? After all, presumably pharmaceutical companies would not engage in DTCA if it didn’t increase their sales. Interpreting whether increased statin utilization is good or bad, however, requires agreement about who should be on statins, which current guidelines lack.

Beyond proving that advertising works, the study also found a stronger effect between DTCA and statin refill rates than new prescriptions. If it is assumed that those patients getting refills are on statins for an appropriate indication, than this offers support for the potential of DTCA to improve patient adherence. Another fascinating finding was a link connecting DTCA to an increased rate of high cholesterol-related outpatient visits for adults 18-45 years old, but not among those 46-65 years old. This can be interpreted different ways. Young adults may be an underserved group that benefit from increased engagement with the health care system. Conversely, it may be that these visits represent over-utilization by a healthy population.

Evidence doesn’t simply make evidence-based policy; it has to be interpreted. Although this study provides some tantalizing results, its impact on policymakers might be lost in translation.

commentary by Matthew Stampfl

Abstract

Importance: The value of direct-to-consumer advertising (DTCA) of prescription drugs is widely debated, as is the effect of DTCA on prescription sales and health care utilization. 

Objective: We examined the association between DTCA intensity for statin medications and prescription sales and cholesterol-related health care utilization. 

Design, Setting, and Participants: We conducted an ecological study for 75 designated market areas from 2005 to 2009 in the United States using linked data regarding televised DTCA volume, non-DTCA marketing and promotion, retail, mail order and long-term care prescription drug sales, prescription drug and ambulatory care health care utilization, and contextual factors such as health care density and socioeconomic status. Main outcomes and measures were volume of sales, number of dispensed prescriptions, and high cholesterol-related outpatient visits. Analyses were conducted in 2016. 

Results: The intensity of rosuvastatin and atorvastatin ad exposures per household varied substantially across designated market areas. After adjustment for socioeconomic, demographic, and clinical characteristics, each 100-unit increase in advertisement viewership was associated with a 2.22% [95% confidence interval (CI), 0.30%–4.19%] increase in statin sales. Similar patterns were observed between DTCA and statin dispensing among the commercially insured. DTCA was associated with increases in high cholesterol-related outpatient visits among adults 18–45 years of age (3.15% increase in visits per 100-unit increase in viewership, 95% CI, 0.98%–5.37%) but not among those 46–65 years of age (0.51%, 95% CI, 1.49% to 2.55%).  

Conclusion: DTCA for statins is associated with increases in statin utilization and hyperlipidemia-related outpatient visits, especially for young adults. 

PMID: 28598891 Chang, HY, et al. Med Care. Epub; 2017 Jun 8

Matthew Stampfl
About Matthew Stampfl

Matthew Stampfl is a medical student at Baylor College of Medicine. More Posts