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health insurance coverage (90.5-96.5%). It was also noted that among individuals withhypertension-related visits, the majority (84.7-88.3%) were 45 years and older.Figure 5.39: Trends in Percentage of Women, Percentage of Individuals with HealthInsurance Coverage and Percentage of Individuals 45 years and Older Among thosewith Hypertension-Related Physician Visits, 1994-200110092.5 90.5 91.193.394.9 93.9 96.593.08085.884.787.388.387.487.887.386.7Percent604058.0 61.256.059.8 59.0 57.7 58.656.32001994 1995 1996 1997 1998 1999 2000 2001YearPercent WomenPercent Individuals with Health Insurance CoveragePercent Individuals 45 years and olderNote – Percent was calculated from total number of individuals with hypertension-related visitsFigure 5.40 presents the trends in percentage of women, percentage ofindividuals with health insurance coverage, and percentage of individuals 45 years andolder among those who received a prescription for advertised antihypertensive drugs.From 1994 to 1996, a majority of prescriptions were written for women (51.7-57.1%),but from 1997 to 2001, fewer prescriptions for antihypertensives were written for womencompared to men (women – 41.8-48.0%). The majority of the individuals who receivedprescriptions for advertised antihypertensives had health insurance coverage (87.2-97.9%) and were 45 years and older (87.4-95.6%).286
Figure 5.40: Trends in Percentage of Women, Percentage of Individuals with HealthInsurance Coverage and Percentage of Individuals 45 years and Older Among thosewho Received Prescriptions for Advertised Antihypertensives, 1994-20011008094.290.889.787.295.1 95.4 95.1 97.992.194.694.492.1 89.792.6 95.687.4Percent604056.2 57.151.745.8 46.8 41.8 44.548.02001994 1995 1996 1997 1998 1999 2000 2001YearPercent WomenPercent Individuals with Health Insurance CoveragePercent Individuals 45 years and older* - Adalat®, Altace®, Capoten®, Cardizem®, Cardura®, Coreg®, Lotensin®, Toprol XL®Note: Percent was calculated from total number of individuals who received a prescription for anadvertised antihypertensive drugThe data for percentage of women, percentage of individuals with coverage, andpercentage of individuals 45 years and older among those who received a prescription foradvertised antihypertensives are provided in Appendix E, F, and G, respectively. Age wasfurther categorized into six groups of individuals who received prescriptions foradvertised antihypertensives: under 15 years, 15 to 24 years, 25 to 44 years, 45 to 64years, 65 to 74 years and 75 years and older. The majority of the prescriptions foradvertised antihypertensives were written for individuals 45 to 64 years of age (28.7-37.6%). The distribution or prescribing patterns for antihypertensives for these differentage categories are provided in Appendix H.287
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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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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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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
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Page 281 and 282: Table 5.6: Number and Percentage of
Page 283 and 284: Figure 5.17: Trends in Percentage o
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Page 287 and 288: Figure 5.20: Trends in Prescription
Page 289 and 290: Since the guidelines for broadcast
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Page 299 and 300: Figure 5.27: Trends in Total Prescr
Page 301 and 302: AntidepressantsDTCA ExpendituresFig
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Page 307 and 308: Figure 5.32: Trends in Percentage o
Page 309 and 310: presented in the methodology, the e
Page 311 and 312: Figure 5.35: Trends in Prescription
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Page 317: Figure 5.38: Trend in the Number of
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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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Page 337 and 338: Increase in the allergy-related vis
Page 339 and 340: Table 5.18: Mixed Model Analysis fo
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Page 345 and 346: The Durbin-Watson statistic for thi
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Page 349 and 350: Mixed Model Analysis with Transform
Page 351 and 352: Table 5.25: Untransformed Mixed Mod
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Page 355 and 356: The significant variables in this a
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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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Table 5.42: Untransformed Mixed Mod
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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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