Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Sol Price School of Public Policy, University of Southern California, Los Angeles.
JAMA Health Forum. 2022 Aug 5;3(8):e222570. doi: 10.1001/jamahealthforum.2022.2570.
Consumers in the US are exposed to unprecedented high levels of direct-to-consumer advertising (DTCA) for prescription drugs, yet there is limited evidence regarding their effect on health-related intentions and beliefs.
To provide evidence on the association of DTCA for prescription drugs with consumer health-related intentions and beliefs.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study recruited participants from a nationally representative sample of individuals at high risk of cardiovascular disease. Participants were randomly assigned into 1 of 3 study arms: (1) exposure to DTCA for heart disease medications (treatment 1 [n = 926]), (2) exposure to DTCA for heart disease medications with price disclosure (treatment 2 [n = 921]), (3) and exposure to nonpharmaceutical advertising (control group [n = 902]). Each study arm viewed five 1-minute video advertisements, totaling 5 minutes of advertising exposure. The 2 treatment arms viewed pharmaceutical advertising videos for 4 heart disease medications, and the control arm viewed nonpharmaceutical advertising videos. Participants then completed a survey questionnaire to measure medication- and lifestyle-related intentions and health-related beliefs and perceptions.
Direct-to-consumer advertising for heart disease medications (treatment 1), DTCA for heart disease medications with price disclosure (treatment 2), and nonpharmaceutical advertising (control group).
The primary outcomes included ordinal measures of medication- and lifestyle-related intentions, health-related beliefs, and brand perceptions.
Among the 2874 included participants (mean [SD] age, 53.8 [7.1] years; 1549 [54%] male) χ2 tests confirmed that there were no statistically significant differences in baseline demographic characteristics across study arms. There was a positive association between DTCA and medication-related behavioral intentions, including intention to switch medication (marginal effect [ME] = 0.004; P = .002) and engage in information-seeking behaviors (ME = 0.02; P = .01). There was no evidence that pharmaceutical DTCA discouraged use of nonpharmacological lifestyle interventions that can help manage heart disease (eg, diet and exercise), and DTCA exposure also had a positive association with consumers' favorable perceptions of pharmaceutical manufacturers (competence: ME = 0.03; P = .01; innovative: ME = 0.03; P = .008). There was no evidence for differential associations of price disclosures in DTCA.
In this cross-sectional study, results showed that brief exposure to pharmaceutical DTCA had a large and positive association with medication-related demand intentions with no offsetting negative spillovers on lifestyle-related intentions. Lack of associations with price disclosure in DTCA suggests that policy makers should consider alternative strategies to promote value-based decision-making for prescription drugs.
美国消费者面临前所未有的高水平处方药直接面向消费者广告（DTCA），但关于其对健康相关意图和信念的影响的证据有限。
提供处方药 DTCA 与消费者健康相关意图和信念之间关联的证据。
设计、设置和参与者：这项横断面研究从心血管疾病高危人群的全国代表性样本中招募参与者。参与者被随机分配到 3 个研究臂之一：（1）暴露于心脏病药物的 DTCA（治疗 1 [n=926]），（2）暴露于心脏病药物的 DTCA 并披露价格（治疗 2 [n=921]），（3）暴露于非药物广告（对照组 [n=902]）。每个研究臂观看了五个 1 分钟的视频广告，总广告时长为 5 分钟。前两个治疗臂观看了 4 种心脏病药物的药物广告视频，对照组观看了非药物广告视频。然后，参与者完成了一份问卷调查，以衡量与药物和生活方式相关的意图以及与健康相关的信念和认知。
心脏病药物的 DTCA（治疗 1），心脏病药物的 DTCA 并披露价格（治疗 2），以及非药物广告（对照组）。
主要结果包括与药物和生活方式相关的意图、健康相关信念和品牌认知的有序测量。
在 2874 名纳入的参与者中（平均[标准差]年龄，53.8[7.1]岁；1549[54%]为男性），卡方检验证实研究臂之间在基线人口统计学特征方面没有统计学上的显著差异。DTCA 与药物相关的行为意图呈正相关，包括换药意向（边际效应[ME]=0.004；P=0.002）和寻求信息行为意向（ME=0.02；P=0.01）。没有证据表明制药 DTCA 抑制了有助于治疗心脏病的非药物生活方式干预措施的使用（例如饮食和运动），而且 DTCA 暴露也与消费者对制药商的有利认知呈正相关（能力：ME=0.03；P=0.01；创新：ME=0.03；P=0.008）。DTCA 中的价格披露没有表现出差异化关联。
在这项横断面研究中，结果表明，短暂接触药物 DTCA 与药物相关需求意图呈强正相关，而对生活方式相关意图没有产生负面影响。DTCA 中缺乏与价格披露相关的关联表明，政策制定者应考虑采用替代策略来促进处方药的基于价值的决策。
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