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Murayama A. Industry-sponsored meal payments are associated with prescriptions and Medicare expenditures on brand-name colchicine in the United States. Int J Rheum Dis 2024; 27:e14962. [PMID: 37923570 DOI: 10.1111/1756-185x.14962] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/11/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
AIM To investigate the association between industry-sponsored meal payments and the prescribing patterns of brand-name colchicines, namely Colcrys and Mitigare, among Medicare beneficiaries in the United States from 2014 to 2021. METHODS This cross-sectional study utilized data from the Open Payments Database and Medicare Part D covering the years 2014 to 2021. The study included 54 836 physicians who submitted more than 10 colchicine claims. Exposure was defined as the receipt of one or more industry-sponsored meals from the manufacturers of Colcrys or Mitigare. The primary outcomes included the likelihood of prescribing Colcrys and Mitigare, as well as the associated number of claims and Medicare expenditures. RESULTS Among 54 836 eligible physicians, 44.9% received meal payments from the Colcrys manufacturer, and 8.0% from the Mitigare manufacturer, over the eight-year study period. The average meal payment value was $14.9 for Colcrys and $15.1 for Mitigare. The receipt of meal payments was significantly associated with an increased likelihood of prescribing Colcrys (odds ratio: 1.24 [95% CI: 1.21-1.27], p < .001) and Mitigare (odds ratio: 3.54 [95% CI: 2.98-4.20], p < .001). Each additional meal payment corresponded with a significant increase in Medicare expenditures: $55.4 (95% CI: $48.3-$62.5, p < .001) for Colcrys and $153.7 (95% CI: $17.7-$289.6, p = .03) for Mitigare. These associations remained consistent across different specialties and genders. CONCLUSION This study reveals that receipt of meal payments from manufacturers of brand-name colchicine was significantly associated with an increased rate of prescriptions for these brand-name drugs, leading to higher Medicare expenditures in the United States.
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Affiliation(s)
- Anju Murayama
- School of Medicine, Tohoku University, Sendai City, Japan
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Tang L, Chen H, Hu X, Fang Z, Liao X, Zhou X, Yang H, Tu T, Zhu Z, Zhou S, Liu Z. Intensive Lipid-Lowering Therapy as per the Latest Dyslipidemia Management Guideline in Predicting Favorable Long-Term Clinical Outcomes in Patients Undergoing Coronary Artery Bypass Grafting: A Retrospective Cohort Study. J Am Heart Assoc 2023; 12:e029397. [PMID: 37804190 PMCID: PMC10757532 DOI: 10.1161/jaha.123.029397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 09/12/2023] [Indexed: 10/09/2023]
Abstract
Background There are limited data on low-density lipoprotein cholesterol (LDL-C) goal achievement per the 2019 European Society of Cardiology/European Atherosclerosis Society dyslipidemia management guidelines and its impact on long-term outcomes in patients undergoing coronary artery bypass grafting (CABG). We investigated the association between LDL-C levels attained 1 year after CABG and the long-term outcomes. Methods and Results A total of 2072 patients diagnosed with multivessel coronary artery disease and undergoing CABG between 2011 and 2020 were included. Patients were categorized by lipid levels at 1 year after CABG, and the occurrence of major adverse cardiovascular and cerebrovascular events (MACCEs) was evaluated. The goal of LDL-C <1.40 mmol/L was attained in only 310 patients (14.9%). During a mean follow-up of 4.2 years after the index 1-year assessment, 25.0% of the patients experienced MACCEs. Multivariable-adjusted hazard ratios (95% CIs) for MACCEs, cardiac death, nonfatal myocardial infarction, nonfatal stroke, revascularization, and cardiac rehospitalization were 1.94 (1.41-2.67), 2.27 (1.29-3.99), 2.45 (1.55-3.88), 1.17 (0.63-2.21), 2.47 (1.31-4.66), and 1.87 (1.19-2.95), respectively, in patients with LDL-C ≥2.60 mmol/L, compared with patients with LDL-C <1.40 mmol/L. The LDL-C levels at 1-year post-CABG were independently associated with long-term MACCEs. Conclusions This retrospective analysis demonstrates that lipid goals are not attained in the vast majority of patients at 1 year after CABG, which is independently associated with the increased risk of long-term MACCEs. Further prospective, multicenter studies are warranted to validate if intensive lipid management could improve the outcomes of patients undergoing CABG.
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Affiliation(s)
- Liang Tang
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Hao Chen
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Xin‐Qun Hu
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Zhen‐Fei Fang
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Xiao‐Bo Liao
- Department of Cardiovascular SurgeryThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Xin‐Min Zhou
- Department of Cardiovascular SurgeryThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Hui Yang
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Tao Tu
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Zhao‐Wei Zhu
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Sheng‐Hua Zhou
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Zhen‐Jiang Liu
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
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Murayama A. Pharmaceutical industry-sponsored meals and prescriptions of biologics for asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2916-2918. [PMID: 37245733 DOI: 10.1016/j.jaip.2023.05.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Anju Murayama
- School of Medicine, Tohoku University, Sendai City, Miyagi, Japan.
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Kamamoto S, Ozaki A, Murayama A. Assessment of Financial Relationships Between Otorhinolaryngologists and Pharmaceutical Companies in Japan Between 2016 and 2019. Cureus 2023; 15:e43633. [PMID: 37719565 PMCID: PMC10503947 DOI: 10.7759/cureus.43633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION There are prevalent financial relationships between physicians and the pharmaceutical industry in medical specialties, including otorhinolaryngology. Although these relationships might cause conflicts of interest, no studies have assessed the size and contents of the financial relationships between otorhinolaryngologists and pharmaceutical companies in Japan. This study aims to evaluate the magnitude, prevalence, and trend of the financial relationship between Japanese otolaryngologists and pharmaceutical companies. METHODS Using payment data publicly disclosed by 92 pharmaceutical companies, we examined the size, prevalence, and trend in personal payments made to the otorhinolaryngologist board certified by the Japanese Society of Otorhinolaryngology-Head and Neck Surgery (JSO-HNS) between 2016 and 2019 in Japan. Furthermore, differences in payments were evaluated by whether otolaryngologists were clinical practice guideline authors, society board members, and academic journal editors or not. Trends in payments were evaluated by generalized estimating equations. RESULTS Of 8,190 otorhinolaryngologists, 3,667 (44.8%) were paid a total of $13,873,562, in payments for lecturing, consulting, and writing by 72 pharmaceutical companies between 2016 and 2019. The median four-year combined payment per physician was $1,022 (interquartile range: $473-$2,526). Top 1%, 5%, and 10% of otorhinolaryngologists received 42.3% (95% confidence interval (95% CI): 37.2%-47.4%), 69.3% (95% CI: 65.9%-72.8%), and 80.6% (95% CI: 78.3%-82.9%) of overall payments, respectively. The median payments per physician were significantly higher among otorhinolaryngologists authoring clinical practice guidelines ($11,522), society board members ($22,261), and journal editors ($35,143) than those without. The payments and number of otorhinolaryngologists receiving payments remained stable between 2016 and 2019. CONCLUSION This study demonstrates that a minority but a large number of otorhinolaryngologists received personal payments from pharmaceutical companies for the reimbursement of lecturing, consulting, and writing in Japan. Large amounts of these personal payments were significantly concentrated on a small number of leading otorhinolaryngologists.
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Affiliation(s)
- Sae Kamamoto
- School of Medicine, Hamamatsu University, Hamamatsu, JPN
| | - Akihiko Ozaki
- Surgery, Teikyo University Graduate School of Public Health, Tokyo, JPN
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Murayama A, Kamamoto S, Saito H, Ozaki A. Pharmaceutical payments to Japanese board-certified dermatologists: a 4-year retrospective analysis of personal payments from pharmaceutical companies between 2016 and 2019. Sci Rep 2023; 13:7425. [PMID: 37156855 PMCID: PMC10167352 DOI: 10.1038/s41598-023-34705-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/05/2023] [Indexed: 05/10/2023] Open
Abstract
There are prevalent financial relationships between dermatologists and pharmaceutical companies in Japan. However, little was known about the extent of whole picture of the personal payments made to dermatologists by pharmaceutical companies. This study aimed to examine the personal payments to the board-certified dermatologists by the Japanese Dermatological Association from the pharmaceutical companies between 2016 and 2019. Using the publicly disclosed payments data by the pharmaceutical companies between 2016 and 2019, we evaluated the magnitude, prevalence, and trends in the personal payments made to all board-certified dermatologists for the lecturing, writing, and consulting compensations. The payments were descriptively analyzed overall and by dermatologist demographics. Additionally, the payment trends were assessed by generalized estimating equation models. Of 6883 active board-certified dermatologists, 3121 (45.3%) received a total of $33,223,806 personal payments between 2016 and 2019. The median per-physician payments and number of payments (interquartile range) were $1737 ($613-$5287) and 4.0 (2.0-10.0) over the 4 years, respectively. Only top 1%, 5%, 10% of dermatologists received 41.7% (95% confidence interval [CI] 38.2-45.1%), 76.9% (95% CI 74.7-79.1%), and 87.6% (95% CI 86.2-88.9%) of overall payments. The number of dermatologists receiving payments and per-dermatologist payments increased by 4.3% (95% CI 3.1‒5.5%, p < 0.001) and 16.4% (95% CI 13.5‒19.4%, p < 0.001) each year. The board-certification in dermatology-oncology, in cosmetic dermatology, and male sex were significantly associated with higher personal payments with relative monetary values of 2.29 (95% CI 1.65-3.19, p < 0.001), 3.16 (95% CI 1.89-5.26, p < 0.001), and 5.38 (95% CI 4.12-7.04, p < 0.001). Less than half of Japanese board-certified dermatologists received lower personal payments from the pharmaceutical companies than those to other specialists. However, these personal payments were increasingly more prevalent and greater over the 4 years.
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Affiliation(s)
- Anju Murayama
- Tohoku University School of Medicine, Sendai, Miyagi, Japan.
| | - Sae Kamamoto
- Faculty of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hiroaki Saito
- Medical Governance Research Institute, Minato-Ku, Tokyo, Japan
- Department of Internal Medicine, Soma Central Hospital, Soma, Fukushima, Japan
| | - Akihiko Ozaki
- Faculty of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
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Mitchell A, Sarpatwari A, Bach PB. Industry Payments to Physicians Are Kickbacks. How Should Stakeholders Respond? JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2022; 47:815-833. [PMID: 35867550 PMCID: PMC11107028 DOI: 10.1215/03616878-10041205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Payments from the pharmaceutical industry to US physicians are common. In determining which payments rise to the level of an illegal kickback under the Anti-Kickback Statute (AKS), the Department of Health and Human Services' Office of Inspector General (OIG) has stated in nonbinding guidance that influencing or "swaying" physician prescribing is key. OIG has highlighted as a compliance standard the Pharmaceutical Research and Manufacturers of America Code on Interactions with Health Professions, which stipulates that permissible payments are those that do not interfere with prescribing. However, recent evidence has shown that most payments influence physician prescribing, driving higher prescription drug costs by increasing use of brand-name and low-value drugs. This evidence implies that many payments that are currently commonplace could be subject to prosecution under AKS. Given that these payments increase costs to patients and the health care system, there is a public interest in curtailing them. This article proposes a range of actions available to stakeholders-including industry, providers, regulators, and payers-to mitigate the cost-increasing effect of industry payments to physicians.
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Muacevic A, Adler JR, Saito H, Tanimoto T, Ozaki A. Trends in Industry Payments to Diabetologists and Endocrinologists in the United States During the COVID-19 Pandemic. Cureus 2022; 14:e32643. [PMID: 36654586 PMCID: PMC9842187 DOI: 10.7759/cureus.32643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Limited evidence suggests there were substantial amounts of payments from the healthcare industry to diabetologists and endocrinologists in the United States before the coronavirus disease 2019 (COVID-19) pandemic period. However, there is no study on how these industry payments changed during the COVID-19 pandemic. This study aimed to evaluate trends in non-research industry payments to physicians specializing in diabetology and endocrinology in the United States during the COVID-19 pandemic. Methods Using the open payments database between 2013 and 2021, we examined trends in general payments made to physicians whose primary specialty was diabetology and endocrinology by the healthcare industry in the United States. Trends in industry payments during the COVID-19 pandemic were evaluated by interrupted time series analysis with generalized estimating equation models. Results Of 7965 active endocrinologists and diabetologists, 6991 (87.8%) received one or more general payments from the healthcare industry in the United States between August 2013 and December 2021. Median per-physician payments were $116.68 (interquartile range (IQR): $41.66-$390.00) before the COVID-19 pandemic period and $97.91 (IQR: $32.81-$314.04) during the COVID-19 pandemic period. Monthly per-physician payments, the number of per-physician payments, and the number of physicians receiving payments decreased by 61.0% (95% confidence interval (95% CI): 58.1%-63.7%, p<0.001), 59.2% (95% CI: 57.9%-60.4%, p<0.001), and 39.7% (95% CI: 38.3%-41.0%, p<0.001) at the onset of the COVID-19 pandemic (March 2020), compared to those before pandemic period, respectively. Conclusion The non-research payments to endocrinologists and diabetologists from the healthcare industry sharply decreased by about 60% in payment amounts due to the COVID-19 pandemic in the United States.
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Murayama A, Kamamoto S, Saito H, Yamada K, Bhandari D, Shoji I, Mamada H, Kawashima M, Yamashita E, Kusumi E, Sawano T, Sapkota B, Tanimoto T, Ozaki A. Pharmaceutical Payments to Japanese Board-Certified Infectious Disease Specialists: A Four-Year Retrospective Analysis of Payments from 92 Pharmaceutical Companies between 2016 and 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127417. [PMID: 35742661 PMCID: PMC9223711 DOI: 10.3390/ijerph19127417] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/31/2022] [Accepted: 06/14/2022] [Indexed: 01/30/2023]
Abstract
Backgrounds: Conflict of interest with pharmaceutical companies is one of the most concerned issues in infectious diseases. However, there is a lack of whole picture of detailed payments in Japan. Methods: This retrospective study assessed financial relationships between pharmaceutical companies and all infectious disease specialists board-certified by the Japanese Association for Infectious Disease, using publicly disclosed payment data from 92 major pharmaceutical companies. Descriptive analyses were conducted for the payments. Payment trends were examined by the generalized estimating equations. Results: Of 1614 board-certified infection disease specialists, 1055 (65.4%) received a total of $17,784,070 payments, corresponding to 21,680 contracts between 2016 and 2019. The mean ± SD and median (interquartile range: IQR) were $16,857 ± $45,010 and $3183 ($938–$11,250) in payments. All board executive members of Japanese Association of Infectious Disease received higher payments averaging $163,792. There were no significant changes in payments per specialist (annual change rate: −1.4% [95% CI: −4.7–2.3%], p = 0.48) and prevalence of specialists with payments (annual change rate: −1.4% [95% CI: −3.1–0.2%], p = 0.093) over the four years. Conclusion: There were substantial financial relationships between pharmaceutical companies and board-certified infectious disease specialists in Japan. Furthermore, high ranked specialists such as those in the executive board had stronger financial ties with the companies.
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Affiliation(s)
- Anju Murayama
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
- School of Medicine, Tohoku University, Sendai City 980-8577, Miyagi, Japan
- Correspondence: ; Tel.: +81-90-6321-6996
| | - Sae Kamamoto
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
- School of Medicine, Hamamatsu University, Hamamatsu City 431-2102, Shizuoka, Japan
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kosei Hospital, Sendai City 980-0873, Miyagi, Japan;
| | - Kohki Yamada
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
| | - Divya Bhandari
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
| | - Iori Shoji
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
| | - Hanano Mamada
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
| | - Moe Kawashima
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
| | - Erika Yamashita
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
| | - Eiji Kusumi
- Navitas Clinic Shinjuku, Shinjuku-ku 160-0022, Tokyo, Japan;
| | - Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki City 972-8322, Fukushima, Japan;
| | - Binaya Sapkota
- Nobel College Faculty of Health Sciences, Pokhara University, Kathmandu 33700, Nepal;
| | - Tetsuya Tanimoto
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
- Department of Internal Medicine, Navitas Clinic, Tachikawa City 160-0022, Tokyo, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki City 972-8322, Fukushima, Japan
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Inoue K, Goto A, Kondo N, Shinozaki T. Bias amplification in the g-computation algorithm for time-varying treatments: a case study of industry payments and prescription of opioid products. BMC Med Res Methodol 2022; 22:120. [PMID: 35468735 PMCID: PMC9036763 DOI: 10.1186/s12874-022-01563-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background It is often challenging to determine which variables need to be included in the g-computation algorithm under the time-varying setting. Conditioning on instrumental variables (IVs) is known to introduce greater bias when there is unmeasured confounding in the point-treatment settings, and this is also true for near-IVs which are weakly associated with the outcome not through the treatment. However, it is unknown whether adjusting for (near-)IVs amplifies bias in the g-computation algorithm estimators for time-varying treatments compared to the estimators ignoring such variables. We thus aimed to compare the magnitude of bias by adjusting for (near-)IVs across their different relationships with treatments in the time-varying settings. Methods After showing a case study of the association between the receipt of industry payments and physicians’ opioid prescribing rate in the US, we demonstrated Monte Carlo simulation to investigate the extent to which the bias due to unmeasured confounders is amplified by adjusting for (near-)IV across several g-computation algorithms. Results In our simulation study, adjusting for a perfect IV of time-varying treatments in the g-computation algorithm increased bias due to unmeasured confounding, particularly when the IV had a strong relationship with the treatment. We also found the increase in bias even adjusting for near-IV when such variable had a very weak association with unmeasured confounders between the treatment and the outcome compared to its association with the time-varying treatments. Instead, this bias amplifying feature was not observed (i.e., bias due to unmeasured confounders decreased) by adjusting for near-IV when it had a stronger association with the unmeasured confounders (≥0.1 correlation coefficient in our multivariate normal setting). Conclusion It would be recommended to avoid adjusting for perfect IV in the g-computation algorithm to obtain a less biased estimate of the time-varying treatment effect. On the other hand, it may be recommended to include near-IV in the algorithm unless their association with unmeasured confounders is very weak. These findings would help researchers to consider the magnitude of bias when adjusting for (near-)IVs and select variables in the g-computation algorithm for the time-varying setting when they are aware of the presence of unmeasured confounding. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01563-3.
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Affiliation(s)
- Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Floor 2, Science Frontier Laboratory, Yoshida-konoe-cho, Sakyo-ku, Kyoto, 604-8146, Japan. .,Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
| | - Atsushi Goto
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Floor 2, Science Frontier Laboratory, Yoshida-konoe-cho, Sakyo-ku, Kyoto, 604-8146, Japan.,Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
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Inoue K, Figueroa JF, Kondo N, Tsugawa Y. Changes in industry marketing payments to physicians during the covid-19 pandemic: quasi experimental, difference-in-difference study. BMJ MEDICINE 2022; 1:e000219. [PMID: 36936580 PMCID: PMC9978761 DOI: 10.1136/bmjmed-2022-000219] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/26/2022] [Indexed: 11/04/2022]
Abstract
Objective To determine changes in industry marketing payments to physicians due to the covid-19 pandemic. Design Quasi experimental, difference-in-difference study. Data source US nationwide database of licensed physicians, the National Plan and Provider Enumeration System, which was linked to a database of industry marketing payments made to physicians, Open Payments. Population All licensed US physicians from 2018 to 2020 and those who received payments from industry. Main outcome measures Changes in the value and the number of monthly industry payments physician received before (January-February 2020) and during the pandemic (April-December 2020) were assessed, adjusting for physicians' characteristics (gender and specialty). As the control, data for the same months in 2019 were used. Industry payments by type of payments (eg, meals, travel, consulting fees, speaker compensation, honorariums), were also examined. Results Among 880 589 US physicians included in this study, 267 463 (30.4%) physicians received a total of 4 117 482 non-research payments with $626 million ($710 per physician; £610; €708) in 2020 (40-44% decrease from $1047m in 2018 and $1115m in 2019). Industry payments decreased significantly in the months of the covid-19 pandemic (adjusted change in the value of -48.4%; 95% confidence interval -50.6 to -46.2; P<0.001; and adjusted change in the number of -47.4%, 95% confidence interval -47.7 to -47.1; P<0.001), particularly for meals and travel fees. No evidence was seen of a decrease in the number of industry payments for consulting and honorariums. A similar pattern was observed across physicians' gender and specialty. Conclusions Industry payments to physicians, particularly those involving physical interactions such as meals and travel, substantially decreased during the pandemic. How such changes affect prescription practices and the quality of clinical practice in the long term should be investigated.
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Affiliation(s)
- Kosuke Inoue
- Department of Social Epidemiology, Kyoto University, Kyoto, Japan
| | - Jose F Figueroa
- Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Cambridge, MA, USA
- Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Naoki Kondo
- Department of Social Epidemiology, Kyoto University, Kyoto, Japan
- Department of Health and Social Behavior, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yusuke Tsugawa
- General Internal Medicine and Health Services Research, UCLA, Los Angeles, CA, USA
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Association between industry payments and prescriptions of long-acting insulin: An observational study with propensity score matching. PLoS Med 2021; 18:e1003645. [PMID: 34061852 PMCID: PMC8205129 DOI: 10.1371/journal.pmed.1003645] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 06/15/2021] [Accepted: 05/04/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The rapidly increased spending on insulin is a major public health issue in the United States. Industry marketing might be one of the upstream determinants of physicians' prescription of long-acting insulin-the most commonly used and costly type of insulin, but the evidence is lacking. We therefore aimed to investigate the association between industry payments to physicians and subsequent prescriptions of long-acting insulin. METHODS AND FINDINGS Using the databases of Open Payments and Medicare Part D, we examined the association between the receipt of industry payments for long-acting insulin in 2016 and (1) the number of claims; (2) the costs paid for all claims; and (3) the costs per claim of long-acting insulin in 2017. We also examined the association between the receipt of payments and the change in these outcomes from 2016 to 2017. We employed propensity score matching to adjust for the physician-level characteristics (sex, years in practice, specialty, and medical school attended). Among 145,587 eligible physicians treating Medicare beneficiaries, 51,851 physicians received industry payments for long-acting insulin worth $22.3 million. In the propensity score-matched analysis including 102,590 physicians, we found that physicians who received the payments prescribed a higher number of claims (adjusted difference, 57.8; 95% CI, 55.8 to 59.7), higher costs for total claims (adjusted difference, +$22,111; 95% CI, $21,387 to $22,836), and higher costs per claim (adjusted difference, +$71.1; 95% CI, $69.0 to $73.2) of long-acting insulin, compared with physicians who did not receive the payments. The association was also found for changes in these outcomes from 2016 to 2017. Limitations to our study include limited generalizability, confounding, and possible reverse causation. CONCLUSIONS Industry marketing payments to physicians for long-acting insulin were associated with the physicians' prescriptions and costs of long-acting insulin in the subsequent year. Future research is needed to assess whether policy interventions on physician-industry financial relationships will help to ensure appropriate prescriptions and limit overall costs of this essential drug for diabetes care.
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