24 March 2023

Drug Benefit Versus Advertising

Welcome back. Several years ago, I blogged: Maybe it’s me and my TV viewing habits…Whatever the reason, I’m seeing an increasing number of ads for drugs, particularly prescription drugs. Presumably, TV viewers are supposed to see the ad, pay attention if the drug treats a malady they or a loved one have, remember the product name and suggest it to their physicians, because the billions of dollars pharmaceutical companies spend marketing directly to physicians isn’t enough. (see Drug Safety).

Should direct-to-consumer drug advertising be permitted? (graphic by Canadian Health Services Research Foundation, from courses.cherylcline.org/matthewbrooks/2017/03/26/module-5-blog-should-direct-to-consumer-drug-advertising-be-permitted).

Although it wasn’t the research focus, a recent study noted that direct-to-consumer advertising--allowed only by the U.S. and New Zealand--is indeed associated with increased patient requests for advertised drugs and the increased chance that clinicians will prescribe them.

That recent study was conducted by researchers affiliated with Johns Hopkins Bloomberg School of Public Health and Johns Hopkins University. They were investigating drug characteristics associated with direct-to-consumer advertising in an effort to inform policy conversations about the benefits and harms of this advertising practice.

Data Collection
The researchers examined 134 of the 150 top-selling branded prescription drugs in the U.S. in 2020 using data from IQVIA National Sales Perspectives, which projects U.S. national estimates based on 90% of the pharmaceutical market. IQVIA ChannelDynamics data provided promotional spending for individual products across product sampling, clinician contacts, meetings and events, journals, mail as well as direct-to-consumer advertising. The last encompassed digital, magazine, newspaper, outdoor (e.g., billboards), radio and television. 

Descriptive characteristics of 150 top-selling drugs as measured by 2020 drug sales (from table 1, jamanetwork.com/journals/jama/fullarticle/2801060).
Among the principal data used were: total 2020 product sales, added clinical benefit (high vs. low), single vs. many indications that lead to its recommendation, off-label use (yes vs. no), molecule type, nature of condition treated (chronic, acute or both), clinician vs self administration, generic availability, US Food and Drug Administration approval year, World Health Organization anatomical therapeutic chemical classification, 2020 Medicare annual mean spending per beneficiary, percent of manufacturer sales attributable to the product, market size and market competitiveness.

Because the US doesn’t rate prescription drugs, “added clinical benefit” used ratings from assessment agencies in France and Canada. Both countries prioritize evidence from randomized trials that compare the new drug to an existing treatment.

Wrap Up
Holding the percent of total promotional spending allocated to direct-to-consumer advertising as the dependent variable, the researchers’ statistical analyses found (1) most of the top-selling prescription drugs sold in 2020 were rated as offering low added benefit and (2) spending allocated to direct-to-consumer advertising averaged 14.3% more for low-benefit drugs than for high-benefit drugs.

The researchers also found a large variation in spending on direct-to-consumer advertising among the drugs analyzed. Manufacturers of six of the top-selling drugs spent more than 90% of their promotional budget targeting consumers. These drugs include treatment options for motor neuropathy, various cancers, multiple sclerosis and HIV. Drugs treating metabolism and the digestive tract had a significantly lower share of promotional spending on direct-to-consumer advertising.

So, the number of ads for prescription drugs will likely increase even more. What’s worse, most of those ads are probably for low-benefit drugs. Thanks for stopping by.

Study of drug characteristics and direct-to-consumer advertising in JAMA: jamanetwork.com/journals/jama/fullarticle/2801060
Article on study on EurekAlert! website: www.eurekalert.org/news-releases/978469
Available IQVIA data. Accessed Sep 1, 2022: www.iqvia.com/insights/the-iqvia-institute/available-iqvia-data

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