Cancer patients whose oncologists are paid by industry appear more likely to receive some non-recommended and low-cost treatments, a published US study finds. BMJ Today.
The finding raises potential concerns about quality of care, and the researchers say it may be worth re-examining the current state of private payments to physicians from the pharmaceutical industry.
Research shows a consistent link between industry payments and behavioral determinants, but whether paying physicians has positive or negative consequences for patient care has not been empirically assessed, the researchers say.
To explore this further, they identified Medicare claims data from 2014-19 for patients with a new cancer diagnosis who were at risk of receiving one of four non-recommended (discourageable by guidelines) or low-cost (providing no increased benefit while being more expensive ) ) of medicine.
Two non-recommended drugs were denosumab, a bone-modifying drug for castration-sensitive prostate cancer, and granulocyte colony-stimulating factor (GCSF) to prevent neutropenic fever in patients receiving chemotherapy.
Two lower-cost drugs were nab-paclitaxel instead of paclitaxel for patients with breast or lung cancer, and use of branded cancer drugs when generic or similar versions were available.
The researchers then used Open Payments (a database of financial relationships between companies and doctors) to identify each patient’s assigned oncologist, noting any payments received from the four drug manufacturers in the year prior to the patient’s diagnosis.
Results showed that the proportion of patients receiving non-recommended denosumab within six months of diagnosis was 31.4% for those who did not receive oncologist payment and 49.5% for those who did.
The corresponding values were 26.6% v 32.1% for GCSF, 7.3% v 15.1% for nabpaclitaxel, and 88.3% v 83.5% for the branded drug.
After accounting for patient characteristics including age, preexisting conditions, and income, payments from industry were associated with 17.5% greater use of denosumab, 5.8% greater use of GCSF, and 7.6% greater use of NAB. paclitaxel, but less use of branded drugs (−4.6%).
Smaller effects were observed after further adjustment for physician characteristics, including specialty area and practice setting. For example, payments from industry were associated with 7.4% greater use of denosumab and 1.7% greater use of nabpaclitaxel, but not with GCSF or branded drugs.
This is an observational study so it can only conclude an association between industry payments and prescribing and cannot infer causation, and the authors believe that misclassification in claims data and their focus on a narrow group of patients and interventions may have influenced their results.
However, they say that the influence of industry payments on physician behavior is well established and that this research suggests that this influence may have a negative impact on the care of individual patients.
Given the potential quality-of-care concerns raised by this study, it may be appropriate to reexamine the current status of private payments to physicians from the pharmaceutical industry, they wrote.
And they say more research is needed to better characterize whether, and to what degree, the observed relationship between payment and poor quality of care extends to other settings.
Mitchell, A.Pet al. (2023). Pharmaceutical industry payments and supply of non-recommended and low-cost cancer drugs: population-based cohort study. BMJ. doi.org/10.1136/bmj-2023-075512.