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increase in number of prescriptions written for advertised antilipemics was in 1997 whenit increased by 50.0 percent from 11.7 million in 1996 to 17.5 million in 1997.Overall, DTCA expenditures, number of lipid-related visits, and number ofprescriptions increased by 979.6 percent, 240.4 percent and 561.5 percent, respectivelyfrom 1994 to 2001. Taking into account the relaxation of guidelines in 1997, the DTCAexpenditures decreased slightly by 0.1 percent in 1998. However, the number of lipidrelatedvisits and number of prescriptions written for antilipemics written increased by12.1 percent and 32.7 percent, respectively, in 1998 from the previous year.The number of prescriptions written surpassed the number of lipid-related visits in1997 and continued to 2001. Furthermore, for some visits patients who were diagnosedwith hyperlipidemia were not necessarily prescribed an advertised antilipemic drug andvice-versa. Table 5.6, presents the trends in physician visits when a diagnosis forhyperlipidemia was reported and/or at least one advertised antilipemic drug wasprescribed.The proportion of lipid-related visits when no antilipemic drug was prescribeddecreased from 54.7 percent in 1994 to 30.2 percent in 1998, but increased slightly to31.4 percent in 1999. The percentage of visits when no antilipemic drug was prescribedbut hyperlipidemia was reported decreased in 2000 to 27.0 percent and increased to 32.3percent in 2001. The percentage of visits when advertised antilipemics were prescribed,but hyperlipidemia was not reported (not lipid-related visit) increased from 29.4 percentin 1994 to 43.8 percent in 1998, decreased to 41.1 percent in 1999 and increased again in2000 (48.2%).248
Table 5.6: Number and Percentage of Lipid-Related Physician Visits and/or Visitswhen at Least One Advertised Antilipemic Drug* was Prescribed, 1994-2001Year1994(%)1995(%)1996(%)1997(%)1998(%)1999(%)2000(%)2001(%)Advertised DrugNot PrescribedLipid-RelatedVisit7,273,832(54.74%)8,338,321(48.72%)8,963,027(43.55%)9,256,573(34.80%)9,948,990(30.18%)11,991,434(31.36%)12,327,130(27.04%)18,874,285(32.29%)Number of VisitsAdvertised Drug PrescribedNot Lipid-RelatedVisit3,907,058(29.40%)5,385,023(31.47%)6,900,853(33.53%)10,064,016(37.84%)14,432,181(43.78%)15,716,106(41.10%)21,950,938(48.15%)26,519,700(45.37%)Lipid-relatedVisit2,106,512(15.85%)3,390,763(19.81%)4,717,667(22.92%)7,275,236(27.35%)8,582,022(26.04%)10,534,050(27.55%)11,314,230(24.82%)13,055,872(22.34%)*- Baycol®, Lescol®, Lipitor®, Mevacor®, Pravachol®, Zocor®TotalNumber ofVisits13,287,402(100%)17,114,107(100%)20,581,547(100%)26,595,825(100%)32,963,193(100%)38,241,590(100%)45,592,298(100%)58,449,857(100%)Figure 5.16 presents the trend in number of prescriptions written for each of theadvertised antilipemic drugs from 1994 to 2001. The data for the number of prescriptionswritten for each of the antilipemic drugs are provided in Appendix D. In 1994 and 1995,a majority of the prescriptions were written for Mevacor® (1994 – 3.3 million, 1995 –3.5 million) but Zocor® was the most heavily prescribed antilipemic in 1996 (3.9million) and 1997 (6.8 million). The number of prescriptions written for Mevacor®steadily increased until 1996, following which it began decreasing each year until 2000and increased slight in 2001. The number of prescriptions written for Zocor® increasedsteadily from 1994 to 2001 with sharp increases in 1995 (119.8%) followed by 2000(52.5%).249
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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%,
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Table 2.2: Prevention Magazine Surv
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eported that the physician recommen
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Maddox and Katsanis in a study publ
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drug, but not the disease or condit
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and 35.0 percent were prompted to h
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Glasgow et al. identified factors r
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Time, Inc. conducted two surveys of
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not be disappointed in the physicia
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quit smoking were not aware of it.
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2001 study by Allison-Ottey et al.
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and perceived risk. Argument qualit
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esults were obtained from most stud
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In 1997, IMS Health along with Phys
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medication and 7.0 percent gave the
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Results of the studies described in
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The study reported that 46.0 percen
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setting were more likely to have a
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advertising to build brand loyalty
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advertisements, headlines and subhe
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offer to provide more information i
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was increased, recall of risk infor
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SummaryConsumers are increasingly a
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including drugs used to treat high
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the increased prescription drug exp
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Office focus cluster had high expen
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especially detailing. This made it
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to a 47.8 percent increase in presc
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enign prostatic hypertrophy. 311 Ev
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which helped assess the impact of D
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elationship was significant only af
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DTCA expenditures and market share
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classes accounted for 75.0 percent
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DTCA expenditures along with prescr
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eneficiaries with coverage may rece
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utilization of prescription drugs i
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who were uninsured or were enrolled
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Access to Care and Utilization of P
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Among Medicare beneficiaries, suppl
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coverage filled fewer prescriptions
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than men and are receive more presc
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the prescription drug accounted for
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vs. 17.9%) or heavy users (21.4% vs
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visits than men. In 1998, the avera
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each household was causally associa
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eports, employment status, and read
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Demographics (Age and Gender) and U
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drugs use was largely due to drugs
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The study results indicated that th
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though the difference in the averag
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According to the study based on dat
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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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Page 233 and 234: As discussed in Chapter 2, with the
Page 235 and 236: The total monthly advertising expen
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Page 239 and 240: Table 4.2: United States City Avera
Page 241 and 242: including chronic conditions (e.g.,
Page 243 and 244: 2000. The ICD-9 CM code for irritab
Page 245 and 246: The ICD-9 CM codes used to identify
Page 247 and 248: errors, the significance of the par
Page 249 and 250: presence of autocorrelation, data w
Page 251 and 252: measured for each drug over a perio
Page 253 and 254: August 1997 and September 1997 to A
Page 255 and 256: CHAPTER 5: RESULTSChapter 5 will pr
Page 257 and 258: $39.8 million in 1995 accounting fo
Page 259 and 260: each year to $1,091.7 million in 19
Page 261 and 262: The number of months represent the
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Page 269 and 270: Figure 5.8: Trend in the Number of
Page 271 and 272: Since 1997, nine out of ten individ
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Page 275 and 276: The total DTCA expenditures for ant
Page 277 and 278: Figure 5.14: Trend in DTCA Expendit
Page 279: 1994 to $14.3 million in 1995, but
Page 283 and 284: Figure 5.17: Trends in Percentage o
Page 285 and 286: Prescription Drug ExpendituresThis
Page 287 and 288: Figure 5.20: Trends in Prescription
Page 289 and 290: Since the guidelines for broadcast
Page 291 and 292: Gastrointestinal-Related Physician
Page 293 and 294: visits and number of prescriptions
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Page 297 and 298: 64.0%), had health insurance covera
Page 299 and 300: Figure 5.27: Trends in Total Prescr
Page 301 and 302: AntidepressantsDTCA ExpendituresFig
Page 303 and 304: The total DTCA expenditures increas
Page 305 and 306: percentage of visits when the visit
Page 309 and 310: presented in the methodology, the e
Page 311 and 312: Figure 5.35: Trends in Prescription
Page 313 and 314: heavily advertised antihypertensive
Page 315 and 316: antihypertensives and number of hyp
Page 317 and 318: Figure 5.38: Trend in the Number of
Page 321 and 322: study, total drug expenditures did
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Page 325 and 326: In the dataset for mixed model anal
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Page 329 and 330: 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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Table 5.48: Test Statistics for Ord
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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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Table 5.63: Test Statistics for Ord
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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
Page 545 and 546:
Angel JE. Drug advertisements and p
Page 547 and 548:
Cain G. A remedy for rising drug co
Page 549 and 550:
Eng HJ, Lairson DR. Prescribed medi
Page 551 and 552:
Goldman DP, Joyce GF, Escarce JJ, e
Page 553 and 554:
IMS-Health. Paper presented at: Pha
Page 555 and 556:
Lipsky MS, Taylor CA. The opinions
Page 557 and 558:
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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