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Ambulatory Health Care Data: NAMCS Scope and Sample Design. National Center forHealth Statistics. Available at: www.cdc.gov/nchs/about/major/ahcd/sampnam.htm.Accessed August, 2003.Attitudes and behaviors associated with direct-to-consumer promotion of prescriptiondrugs. Center for Drug Evaluation and Research, FDA. 1999. Available at:www.fda.gov/cder/ddmac/research.htm. Accessed November, 2002.Bitter pill: The rising prices of prescription drugs for older Americans. Families USA.June 2002. Available at:http://www.familiesusa.org/site/DocServer/BitterPillreport.pdf?docID=261. AccessedSeptember, 2004.The Cable Television Network Service. Description of Methodology. New York:Competitive Media Reporting; 1999:11-12.CBS consumer model: A study of attitudes, concerns and information needs forprescription drugs and related illnesses. New York: CBS Network Television; 1984.The chain pharmacy industry profile: National Association of Chain Drug Stores; 1999.Congressional report advises against prescription drug advertising to consumers.American Pharmacy. January 1985;25(1):18.Consumers taking control with DTC Rx ads. National Consumers League. January 9,2003. Available at: www.ncl.org/dtcpr.html. Accessed April, 2003.Description of Methodology. New York: Competitive Media Reporting; 1999.Description of Methodology. New York: Competitive Media Reporting; 1999:6-25.Description of Methodology. New York: Competitive Media Reporting; 1999:15-21.506
Direct-to-consumer advertisement of prescription drugs: Withdrawal of moratorium.Federal Register. September 9 1985;50:36677-36678.Direct-to-consumer promotion: Public hearing. Federal Register. August 161995;60(158):42581.Documentation for SAS Version 8: Alternate autocorrelation correction methods. SASInstitute, NC. Available at: http://support.sas.com/documentation/onlinedoc/index.html.Accessed August 2004.Documentation for SAS Version 8: Overview for mixed models. SAS Institute, NC.Available at: http://support.sas.com/documentation/onlinedoc/index.html. AccessedAugust 2004.Documentation for SAS Version 8: Regression with autocorrelated errors. SAS Institute,NC. Available at: http://support.sas.com/documentation/onlinedoc/index.html. AccessedAugust 2004.Drug Topics: Red Book: Thomson Healthcare; 1994-2003.DTC ads prompted prescriptions for 7.5 million Americans, APhA/Prevention surveyconcludes. FDC Reports, The Pink Sheet. October 20 1997;59(42):9-10.Enough to make you sick: Prescription drug prices for the elderly. Families USA. June2001. Accessed September, 2004.Establishing the accountability: A strategic research approach to measuring advertisingeffectiveness. Washington DC: Advertising Research Foundation for the AdvertisingCouncil; 1991.The factors fueling rising healthcare costs. PriceWaterhouseCoopers, prepared for theAmerican Association of Health Plans. April 2002. Available at:http://www.aahp.org/InternalLinks/PwCFinalReport.pdf. Accessed November, 2002.507
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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
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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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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 and 518: Percentage of Women Among those who
Page 519 and 520: Appendix FTables for Percentage of
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: BIBLIOGRAPHY. 21 C.F.R. § 202.1(1)
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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