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Percentage of Women Among those who Received Prescriptions for AdvertisedAntidepressants, 1994-2001YearEffexor®%Paxil®%Prozac®%Serzone®%Wellbutrin®%Zoloft®%1994 63.5 68.7 67.2 -- 81.3 70.61995 65.8 68.6 76.9 70.3 60.3 65.41996 68.6 68.5 68.2 60.6 62.6 68.21997 71.1 71.0 70.8 61.0 64.9 70.31998 67.9 73.5 69.2 63.9 49.2 69.81999 77.0 68.5 67.0 67.4 63.2 65.32000 64.2 67.2 62.2 65.7 56.0 71.12001 72.4 76.8 79.1 73.7 51.1 73.4Percentage of Women Among those who Received Prescriptions for AdvertisedAntihypertensive Drugs, 1994-2001YearAdalat®%Altace®%Capoten®%Cardizem®%Cardura®%Coreg® Lotensin®% %ToprolXL®%1994 63.6 61.7 50.9 55.8 45.9 -- 68.1 83.31995 87.7 63.3 54.8 55.9 32.0 -- 56.3 54.31996 46.8 47.0 52.9 59.6 29.5 -- 65.9 45.31997 56.3 65.0 41.8 56.1 20.9 17.5 42.8 52.41998 48.8 42.8 54.5 52.8 28.7 22.9 54.5 46.21999 61.2 47.1 54.2 44.8 16.3 28.7 55.7 40.02000 56.9 49.9 66.8 42.8 22.2 23.3 54.2 46.92001 45.0 30.3 58.1 53.9 20.1 50.0 71.8 52.4486
Appendix FTables for Percentage of Individuals with Health Insurance Coverage Amongthose who Received Prescriptions for Advertised Allergy Medications, Antilipemics,Gastrointestinals, Antidepressants and Antihypertensives Coverage, 1994-2001487
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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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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
Page 467 and 468: coverage were more likely to be pre
Page 469 and 470: antihypertensives reduced drastical
Page 471 and 472: The upheavals in the market may be
Page 473 and 474: a result of advertising, patients m
Page 475 and 476: included in the study, inducing phy
Page 477 and 478: new prescriptions or rather are a r
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
Page 485 and 486: expenditures and prescriptions writ
Page 487 and 488: expenditures for antihypertensives.
Page 489 and 490: also possible that individuals rece
Page 491 and 492: eported increased expenditures by a
Page 493 and 494: awareness for consumers and physici
Page 495 and 496: as well as number of prescriptions
Page 497 and 498: Some studies have reported that wom
Page 499 and 500: Physician VisitsPhysician visits (s
Page 501 and 502: individuals had a positive relation
Page 503 and 504: not only due to DTCA, but also othe
Page 505 and 506: should be repeated for these newer
Page 507 and 508: GLOSSARY OF ACRONYMSAARP - American
Page 509 and 510: Average Wholesale Price of Drugs, 1
Page 511 and 512: Total DTCA Expenditures (in million
Page 513 and 514: Number and Percentage of Prescripti
Page 517: Percentage of Women Among those who
Page 521 and 522: Percentage of Individuals with Heal
Page 523 and 524: Number And Percentage Of Prescripti
Page 527 and 528: DrugCapoten®ToprolXL®Altace®Numb
Page 529 and 530: Appendix HFigures for Percentage of
Page 531 and 532: Percentage of Prescriptions Written
Page 533 and 534: Appendix ITables for Total Prescrip
Page 535 and 536: Total Prescription Drug Expenditure
Page 537 and 538: BIBLIOGRAPHY. 21 C.F.R. § 202.1(1)
Page 539 and 540: Direct-to-consumer advertisement of
Page 541 and 542: Health care in America: Trends in u
Page 543 and 544: 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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