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accounted for a 12.0 percent growth in total prescription drug expenditures for 1999-2000, which translates to an additional $4.20 in sales for every $1.00 spent on DTCA.However, the study concluded that DTCA was important, but was not the primary driverfor the growth. 303Using Scott-Levin’s Source Prescription Audit database, NIHCM also evaluatedthe influence of DTCA expenditures on prescription drug expenditures. The Barentsgroup identified four therapeutic categories including antihistamines, antidepressants,cholesterol reducers, and antiulcerants that accounted for a major portion of theprescription drug expenditures. The top ten most heavily advertised drugs of 1998accounted for a $9.3 billion increase (22.0%) in prescription drug expenditures from 1993to 1998. 304In 1999, advertised drugs were again among the top selling drugs and accountedfor 19.0 percent of the increase in prescription drug expenditures. The top 25 drugs mostheavily advertised drugs of 1999 accounted for 40.7 percent of the increase inprescription drug expenditures. The advertised drugs had a 43.2 percent growth in oneyear sales whereas other drugs had a 13.3 percent growth in sales for 1999. 305 A similarpattern was observed in the year 2000 with few heavily advertised drugs contributing to asignificant increase in prescription drug expenditures. The top 50 most heavily advertiseddrugs during the year 2000 accounted for 31.3 percent of the retail sales and contributed303304305Rosenthal MB, Donohue J, Epstein A, et al. Demand effects of recent changes in prescription drugpromotion. Available at: www.kff.org. Accessed October, 2002.Barents Group L. Issue brief: Factors affecting the growth of prescription drugs expenditures. NationalInstitute for Health Care Management. July, 1999. Available at: www.nihcm.org. Accessed January,2001.Findlay S. Research Brief: Prescription drugs and mass media advertising. National Institute for HealthCare Management. September, 2000. Available at: www.nihcm.org. Accessed April, 2001.114
to a 47.8 percent increase in prescription drug expenditures. 306Thus, the two reports byRosenthal et al. and NIHCM have opposing conclusions regarding the extent of therelationship between DTCA and prescription drug expenditures. The next two sectionswill discuss the literature on relationships between DTCA and utilization factorsincluding physician visits and prescription drug use.DTCA and Physician VisitsEven though there has been much speculation regarding effects of DTCA onphysician visits for conditions and symptoms the advertised drug treats, very few studieshave evaluated this relationship.According to Scott-Levin’s Physician Drug andDiagnosis Audit for January through September 1998, overall office visits increased by2.0 percent. However, visits for advertised conditions increased by 11.0 percent duringthe same time period. 307Using data from Competitive Media Reporting (CMR) and Scott Levin SourcePrescription Audit, Eichner and Maronick examined the impact of advertising ofantihistamines, nail fungus medications, cholesterol-lowering drugs, and antidepressantson physician visits from 1996 to 1998. For these drug categories, DTCA expenditureswas related to the increased physician visits for the condition the drugs treat. Forexample, during the first nine months in 1998, physician visits for allergies increased by10.0 percent. Sporanox ® , a drug used to treat nail fungus, was introduced in 1992 when306307Findlay S, Sherman D, Chockley N, et al. Prescription drugs and mass media advertising, 2000.National Institute for Health Care Management. November 2001. Available at: www.nihcm.org.Accessed January, 2002.Scott-Levin. Patient visits up for DTC conditions. Press Release. November 6, 1998. Available at:www.scottlevin.com. Accessed January, 2002.115
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CopyrightbyRadhika Anantharaman Nai
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EVALUATION OF FACTORS RELATED TO PR
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AcknowledgementsThis dissertation a
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estimate prices of the drugs. Time
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PageRegulatory Changes in 1997 and
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PageCHAPTER 4: METHODOLOGY . . . .
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PagePrescription Drug Expenditures
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PageObjective II . . . . . . . . .
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PageDTCA Expenditures . . . . . . .
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LIST OF TABLES PageTable 2.1: Regul
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PageTable 5.20: Mixed Model Analyse
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PageTable 6.5: Results for Hypothes
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PageFigure 5.4: Trends in Total DTC
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PageFigure 5.30: Trends in Total DT
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CHAPTER 1: INTRODUCTIONBACKGROUNDPr
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Figure 1.2: Annual Percent Change i
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addition, the guidelines for detect
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Direct-to-Consumer Advertising Expe
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of the guidelines, manufacturers fe
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percent whereas private health insu
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public coverage has remained about
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According to the National Center fo
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As mentioned previously, DTCA can a
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one drug prescribed has not increas
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drugs is encouraged. 66 All these f
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(a) To determine the relationships
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enefit of DTCA, many claim that DTC
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persistent and will shop around unt
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advertisements describe and discuss
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These advertisements were aired mai
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During this time, the FDA realized
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included media tours in which physi
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care for their condition, it does n
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It is possible that due to the infl
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mistakenly believe that there is a
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Thus, advertising could cause patie
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Kefauver-Harris Drug Amendments als
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equire the industry to provide a de
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(d) Provide a statement that inform
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choose which side effects and contr
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The studies that tested these effec
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were more likely to have seen an ad
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disease it treats (51.0%). One-half
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advertised drug and on average used
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about a specific brand (1999-13.0%,
Page 95 and 96: Table 2.2: Prevention Magazine Surv
Page 97 and 98: eported that the physician recommen
Page 99 and 100: Maddox and Katsanis in a study publ
Page 101 and 102: drug, but not the disease or condit
Page 103 and 104: and 35.0 percent were prompted to h
Page 105 and 106: Glasgow et al. identified factors r
Page 107 and 108: Time, Inc. conducted two surveys of
Page 109 and 110: not be disappointed in the physicia
Page 111 and 112: quit smoking were not aware of it.
Page 113 and 114: 2001 study by Allison-Ottey et al.
Page 115 and 116: and perceived risk. Argument qualit
Page 117 and 118: esults were obtained from most stud
Page 119 and 120: In 1997, IMS Health along with Phys
Page 121 and 122: medication and 7.0 percent gave the
Page 123 and 124: Results of the studies described in
Page 125 and 126: The study reported that 46.0 percen
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Page 129 and 130: advertising to build brand loyalty
Page 131 and 132: advertisements, headlines and subhe
Page 133 and 134: offer to provide more information i
Page 135 and 136: was increased, recall of risk infor
Page 137 and 138: SummaryConsumers are increasingly a
Page 139 and 140: including drugs used to treat high
Page 141 and 142: the increased prescription drug exp
Page 143 and 144: Office focus cluster had high expen
Page 145: especially detailing. This made it
Page 149 and 150: enign prostatic hypertrophy. 311 Ev
Page 151 and 152: which helped assess the impact of D
Page 153 and 154: elationship was significant only af
Page 155 and 156: DTCA expenditures and market share
Page 157 and 158: classes accounted for 75.0 percent
Page 159 and 160: DTCA expenditures along with prescr
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Page 163 and 164: utilization of prescription drugs i
Page 165 and 166: who were uninsured or were enrolled
Page 167 and 168: Access to Care and Utilization of P
Page 169 and 170: Among Medicare beneficiaries, suppl
Page 171 and 172: coverage filled fewer prescriptions
Page 173 and 174: than men and are receive more presc
Page 175 and 176: the prescription drug accounted for
Page 177 and 178: vs. 17.9%) or heavy users (21.4% vs
Page 179 and 180: visits than men. In 1998, the avera
Page 181 and 182: each household was causally associa
Page 183 and 184: eports, employment status, and read
Page 185 and 186: Demographics (Age and Gender) and U
Page 187 and 188: drugs use was largely due to drugs
Page 189 and 190: The study results indicated that th
Page 191 and 192: though the difference in the averag
Page 193 and 194: According to the study based on dat
Page 195 and 196: Summary of the LiteratureThese stud
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In a model predicting prescription
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Summary of the LiteratureUtilizatio
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esults are skewed, especially when
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Several other factors and market dy
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H 1 : An increase in DTCA expenditu
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H 14 : There is no significant rela
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H 24 : An increase in the proportio
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GastrointestinalsObjective ITo dete
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access to care will be significantl
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AntihypertensivesObjective ITo dete
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Data Collection MethodologyThe basi
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As mentioned earlier, CMR also coll
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oadcasting industry survey conducte
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stated previously, data for the rem
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are to be recorded. A perforation b
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truncated, but this leads to an und
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As discussed in Chapter 2, with the
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The total monthly advertising expen
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64 years, 65-74 years, and 75 years
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Table 4.2: United States City Avera
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including chronic conditions (e.g.,
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2000. The ICD-9 CM code for irritab
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The ICD-9 CM codes used to identify
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errors, the significance of the par
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presence of autocorrelation, data w
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measured for each drug over a perio
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August 1997 and September 1997 to A
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CHAPTER 5: RESULTSChapter 5 will pr
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$39.8 million in 1995 accounting fo
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each year to $1,091.7 million in 19
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The number of months represent the
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print and billboard advertising exp
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1998, but then decreased every year
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advertised allergy medications was
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Figure 5.8: Trend in the Number of
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Since 1997, nine out of ten individ
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increase in prescription drug expen
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The total DTCA expenditures for ant
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Figure 5.14: Trend in DTCA Expendit
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1994 to $14.3 million in 1995, but
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Table 5.6: Number and Percentage of
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Figure 5.17: Trends in Percentage o
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Prescription Drug ExpendituresThis
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Figure 5.20: Trends in Prescription
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Since the guidelines for broadcast
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Gastrointestinal-Related Physician
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visits and number of prescriptions
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prescriptions written decreasing to
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64.0%), had health insurance covera
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Figure 5.27: Trends in Total Prescr
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AntidepressantsDTCA ExpendituresFig
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The total DTCA expenditures increas
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percentage of visits when the visit
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presented in the methodology, the e
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Figure 5.35: Trends in Prescription
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heavily advertised antihypertensive
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antihypertensives and number of hyp
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Figure 5.38: Trend in the Number of
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study, total drug expenditures did
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the advertised drugs from the respe
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In the dataset for mixed model anal
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monthly allergy-related physician v
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Table 5.14: Test Statistics for Ord
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of individuals 45 years and older,
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and time period indicates that the
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values in the dataset for the perce
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Increase in the allergy-related vis
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Table 5.18: Mixed Model Analysis fo
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elated visit increase, the drug exp
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independent variables was associate
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The Durbin-Watson statistic for thi
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untransformed values yielded differ
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Mixed Model Analysis with Transform
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Table 5.25: Untransformed Mixed Mod
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significant in both time periods (T
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The significant variables in this a
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in the drug expenditures for advert
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coefficient for this variable was 6
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years, 45-64 years, and 65 years an
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in time period one compared to time
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Table 5.34: Mixed Model Analysis fo
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every one percent increase in indiv
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less than 25 years, 25-44 years, 45
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significant relationships in both t
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visit {df=235, t=9.64, p
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variables in the equation. For ever
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for gastrointestinal-related visits
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In the absence of the visit variabl
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expenditures, and drug expenditures
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Table 5.46: Mixed Model Analyses fo
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untransformed variables were reconf
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while controlling for other variabl
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1997 to April 2001), which categori
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antidepressants, the analysis was r
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variables in the equation. The perc
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The only age variable that was sign
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prescriptions written for advertise
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in time period two was not supporte
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with health insurance coverage had
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with the transformed variables (Tab
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prescription for advertised antidep
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significant variables indicating th
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antidepressants and were 65 years a
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Time series analysis was employed t
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The results of the mixed model anal
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The significant variables in the an
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number of prescriptions written for
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elated visits, DTCA expenditures fo
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The interaction between DTCA expend
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An increase in number of hypertensi
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in the equation. In time period two
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200 and 360 outlets (spot markets),
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to three reasons for visits were re
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The access or health insurance cove
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• A wider use of the drugs may re
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Table 6.1: Results of the Hypothese
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Tables 6.3 and 6.4 provide a snapsh
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market and advertising of these dru
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(p=0.071). On splitting the dataset
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antidepressants and depression-rela
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The results for age should be inter
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Objective II: Hypotheses for the De
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Objective IV: Hypotheses for Depend
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For every $1,000 increase in DTCA e
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prescriptions written for antidepre
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were positively and significantly r
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coverage were more likely to be pre
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antihypertensives reduced drastical
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The upheavals in the market may be
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a result of advertising, patients m
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included in the study, inducing phy
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new prescriptions or rather are a r
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Objective III: Hypotheses for the D
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Objective IV: Hypotheses for the De
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DTCA ExpendituresSimilar to the rel
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expenditures and prescriptions writ
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expenditures for antihypertensives.
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also possible that individuals rece
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eported increased expenditures by a
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awareness for consumers and physici
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as well as number of prescriptions
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Some studies have reported that wom
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Physician VisitsPhysician visits (s
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individuals had a positive relation
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not only due to DTCA, but also othe
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should be repeated for these newer
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GLOSSARY OF ACRONYMSAARP - American
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Average Wholesale Price of Drugs, 1
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Total DTCA Expenditures (in million
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Number and Percentage of Prescripti
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Percentage of Women Among those who
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Appendix FTables for Percentage of
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Percentage of Individuals with Heal
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Number And Percentage Of Prescripti
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DrugCapoten®ToprolXL®Altace®Numb
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Appendix HFigures for Percentage of
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Percentage of Prescriptions Written
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Appendix ITables for Total Prescrip
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Total Prescription Drug Expenditure
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BIBLIOGRAPHY. 21 C.F.R. § 202.1(1)
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Direct-to-consumer advertisement of
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Health care in America: Trends in u
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Report to the President: Prescripti
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Angel JE. Drug advertisements and p
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Cain G. A remedy for rising drug co
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Eng HJ, Lairson DR. Prescribed medi
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Goldman DP, Joyce GF, Escarce JJ, e
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IMS-Health. Paper presented at: Pha
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Lipsky MS, Taylor CA. The opinions
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Morris LA, Mazis MB, Brinberg D. Ri
Page 559 and 560:
Rosenbach ML, Irvin C, Coulam RF. A
Page 561 and 562:
Smart S, Williams C. Half of drug a
Page 563 and 564:
Wind Y. Pharmaceutical advertising:
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