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- Level of other promotion (samples, detailing) for the product, and quality of theadvertisements.SECTION II: DISCUSSION AND CONCLUSIONThis section will discuss the results for each of the study objectives. Objective IVwhich tested if relationships in Objectives I, II and III were significant for both timeperiods (January 1994 to August 1997, September 1997 to April 2001) will be discussedsimultaneously with the appropriate objective.Objective ITo determine the relationships between DTCA expenditures (allergy medications,antilipemics, gastrointestinals, antidepressants and antihypertensives), access to care,and demographics (age and gender) and physician visits (allergy-related visits, lipidrelatedvisits, gastrointestinal-related visits, depression-related visits, hypertensionrelatedvisits).Objective IV for Physician Visits: To compare relationships between DTCA expenditures,access to care, demographics (age and gender) and physician visits in time periods: (a)January 1994 to August 1997; and (b) September 1997 to April 2001.Tables 6.1 and 6.2 provide the results for hypotheses tests for Objective I andObjective IV (rejected/not rejected), respectively for all five drug classes for thedependent variable frequency of physician visits.412
Table 6.1: Results of the Hypotheses Tests for Objective IObjective I: Hypotheses for the Dependent Variable Frequency of Physician VisitsDTCA ExpendituresAn increase in DTCA expenditures for allergy medications will be significantly relatedto an increase in the number of allergy-related visits.An increase in DTCA expenditures for antilipemic drugs will be significantly related toan increase in lipid-related visits (number of individuals diagnosed withhyperlipidemia).An increase in DTCA expenditures for gastrointestinal drugs will be significantlyrelated to an increase in the number of gastrointestinal-related visits.An increase in DTCA expenditures for antidepressants will be significantly related to anincrease in the number of depression-related visits.An increase in DTCA expenditures for antihypertensive drugs will be significantlyrelated to an increase in hypertension-related visits.Health Insurance CoverageAmong individuals with allergy-related visits, an increase in the proportion ofindividuals with health insurance coverage or access to care will be significantly relatedto an increase in the allergy-related visits.Among individuals diagnosed with hyperlipidemia (lipid-related visits), an increase inthe proportion of individuals with health insurance coverage or access to care will besignificantly related to an increase in the lipid-related visits (number of individualsdiagnosed with hyperlipidemia).Among individuals with gastrointestinal-related visits, an increase in the proportion ofindividuals with health insurance coverage or access to care will be significantly relatedto an increase in the gastrointestinal-related visits.Among individuals with depression-related visits, an increase in the proportion ofindividuals with health insurance coverage or access to care will be significantly relatedto an increase in the depression-related visits.Among individuals with hypertension-related visits, an increase in the proportion ofindividuals with health insurance coverage or access to care will be significantly relatedto an increase in the hypertension-related visits.AgeAn increase in the proportion of older individuals among those with allergy-relatedvisits will be significantly related to an increase in the allergy-related visits.An increase in the proportion of older among those with lipid-related visits (diagnosedwith hyperlipidemia) will be significantly related to an increase in the lipid-relatedvisits.An increase in the proportion of older individuals among those with gastrointestinalrelatedvisits will be significantly related to an increase in the gastrointestinal-relatedvisits.Rejected/NotRejectedRejectedNot RejectedRejectedRejectedRejectedRejected*RejectedRejectedRejectedRejectedRejectedRejectedRejected413
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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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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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Page 419 and 420: Time series analysis was employed t
Page 421 and 422: Table 5.63: Test Statistics for Ord
Page 423 and 424: The results of the mixed model anal
Page 425 and 426: The significant variables in the an
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Page 435 and 436: in the equation. In time period two
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Page 443: • A wider use of the drugs may re
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Page 451 and 452: (p=0.071). On splitting the dataset
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Page 455 and 456: The results for age should be inter
Page 457 and 458: Objective II: Hypotheses for the De
Page 459 and 460: Objective IV: Hypotheses for Depend
Page 461 and 462: For every $1,000 increase in DTCA e
Page 463 and 464: prescriptions written for antidepre
Page 465 and 466: were positively and significantly r
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Page 471 and 472: The upheavals in the market may be
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Page 475 and 476: included in the study, inducing phy
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Page 479 and 480: Objective III: Hypotheses for the D
Page 481 and 482: Objective IV: Hypotheses for the De
Page 483 and 484: DTCA ExpendituresSimilar to the rel
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Page 489 and 490: also possible that individuals rece
Page 491 and 492: eported increased expenditures by a
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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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