Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, United States of America.
Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
PLoS Med. 2021 Jun 1;18(6):e1003645. doi: 10.1371/journal.pmed.1003645. eCollection 2021 Jun.
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.
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.
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.
在美国，胰岛素支出的快速增长是一个主要的公共卫生问题。行业营销可能是医生开长效胰岛素处方的一个上游决定因素——长效胰岛素是最常用和最昂贵的胰岛素类型，但目前证据不足。因此，我们旨在调查医生接受行业报酬与随后开长效胰岛素处方之间的关系。
我们使用 Open Payments 和 Medicare Part D 数据库，考察了 2016 年接受长效胰岛素行业报酬与以下方面的关联：（1）报销数量；（2）所有报销的费用；（3）2017 年每例长效胰岛素的报销费用。我们还考察了从 2016 年到 2017 年期间接受报酬与这些结果变化之间的关联。我们采用倾向评分匹配来调整医生层面的特征（性别、行医年限、专业和就读医学院）。在符合条件的 145587 名治疗 Medicare 受益人的医生中，有 51851 名医生收到了 2230 万美元的长效胰岛素行业报酬。在包括 102590 名医生的倾向评分匹配分析中，我们发现，接受报酬的医生开出的报销数量更多（调整差异，57.8；95%CI，55.8 至 59.7），总报销费用更高（调整差异，+22111 美元；95%CI，21387 美元至 22836 美元），每例长效胰岛素的报销费用更高（调整差异，+71.1 美元；95%CI，69.0 美元至 73.2 美元），而没有接受报酬的医生则没有开出那么多的报销。从 2016 年到 2017 年，这些结果的变化也存在关联。我们的研究存在一些局限性，包括推广受限、混杂因素和可能的反向因果关系。
针对长效胰岛素，医生接受行业营销报酬与他们在次年开长效胰岛素处方和开长效胰岛素的费用相关。未来需要进一步研究，评估针对医生与行业财务关系的政策干预是否有助于确保适当的处方，并限制这种糖尿病护理基本药物的总体费用。
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