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percent of the requests for prescription drugs in Sacramento were fulfilled versus 62.6percent in Vancouver (OR = 2.4, 95% CI = 1.1-3.0). Overall, patients requesting aprescription drug were most likely to receive a new prescription (OR = 8.7, 95% CI =5.4-14.2) after controlling for several factors like health status, age, gender, income,education, drug payment method, physician gender, years in practice, specialty, andcluster sampling for the survey. The physicians were more likely to express ambivalenceabout the treatment when patients requested a certain drug and they prescribed themedication. 215Few patients (2.2%) judged television advertisements to be unreservedly accuratein either city. Some patients in both Sacramento (14.3%) and Vancouver (14.2%)reported that they would go to another physician if their current physician did notprescribe the requested drug. However, a majority of patients in both Sacramento(86.3%) and Vancouver (92.2%) reported that they would trust the physician’s decision ifthey thought that the medication was not needed. DTCA was reported to have more likelyinfluenced patients in Sacramento, in a more legal environment, than patients fromVancouver. The physicians in both cities were highly likely to prescribe these requesteddrugs suggesting a similarity in physician beliefs and attitudes. 216215216Mintzes B, Barer ML, Bassett K, et al. An assessment of the health-system impacts of direct-toconsumeradvertising of prescription medications (DTCA): Volume III - Patient information onmedicines Comparative patient/doctor survey in Vancouver and Sacramento. Center for HealthServices and Policy Research. August 2001. Available at: http://www.chspr.ubc.ca/hpru/pdf/dtca-v3-compsurvey.pdf. Accessed August, 2002.Mintzes B, Barer ML, Bassett K, et al. An assessment of the health-system impacts of direct-toconsumeradvertising of prescription medications (DTCA): Volume III - Patient information onmedicines Comparative patient/doctor survey in Vancouver and Sacramento. Center for HealthServices and Policy Research. August 2001. Available at: http://www.chspr.ubc.ca/hpru/pdf/dtca-v3-compsurvey.pdf. Accessed August, 2002.66
Maddox and Katsanis in a study published in 1997, surveyed Canadians (N=165)to understand patient attitudes toward DTCA and its influence on physician-patientinteraction. The survey presented two scenarios, one in which the consumer is exposed toan advertisement and requests for the drug and the other in which consumer is notexposed to the advertisement, but the physician recommends the advertised drug. Thesescenarios were designed to understand the impact of DTCA on consumers’ perception ofthe interaction with the physician. The results showed a significant difference betweenthe two groups regarding the likelihood of gathering additional information on theadvertised drug (p
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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
Page 47 and 48: According to the National Center fo
Page 49 and 50: As mentioned previously, DTCA can a
Page 51 and 52: one drug prescribed has not increas
Page 53 and 54: drugs is encouraged. 66 All these f
Page 55 and 56: (a) To determine the relationships
Page 57 and 58: enefit of DTCA, many claim that DTC
Page 59 and 60: persistent and will shop around unt
Page 61 and 62: advertisements describe and discuss
Page 63 and 64: These advertisements were aired mai
Page 65 and 66: During this time, the FDA realized
Page 67 and 68: included media tours in which physi
Page 69 and 70: care for their condition, it does n
Page 71 and 72: It is possible that due to the infl
Page 73 and 74: mistakenly believe that there is a
Page 75 and 76: Thus, advertising could cause patie
Page 77 and 78: Kefauver-Harris Drug Amendments als
Page 79 and 80: equire the industry to provide a de
Page 81 and 82: (d) Provide a statement that inform
Page 83 and 84: choose which side effects and contr
Page 85 and 86: The studies that tested these effec
Page 87 and 88: were more likely to have seen an ad
Page 89 and 90: disease it treats (51.0%). One-half
Page 91 and 92: advertised drug and on average used
Page 93 and 94: about a specific brand (1999-13.0%,
Page 95 and 96: Table 2.2: Prevention Magazine Surv
Page 97: eported that the physician recommen
Page 101 and 102: drug, but not the disease or condit
Page 103 and 104: and 35.0 percent were prompted to h
Page 105 and 106: Glasgow et al. identified factors r
Page 107 and 108: Time, Inc. conducted two surveys of
Page 109 and 110: not be disappointed in the physicia
Page 111 and 112: quit smoking were not aware of it.
Page 113 and 114: 2001 study by Allison-Ottey et al.
Page 115 and 116: and perceived risk. Argument qualit
Page 117 and 118: esults were obtained from most stud
Page 119 and 120: In 1997, IMS Health along with Phys
Page 121 and 122: medication and 7.0 percent gave the
Page 123 and 124: Results of the studies described in
Page 125 and 126: The study reported that 46.0 percen
Page 127 and 128: setting were more likely to have a
Page 129 and 130: advertising to build brand loyalty
Page 131 and 132: advertisements, headlines and subhe
Page 133 and 134: offer to provide more information i
Page 135 and 136: was increased, recall of risk infor
Page 137 and 138: SummaryConsumers are increasingly a
Page 139 and 140: including drugs used to treat high
Page 141 and 142: the increased prescription drug exp
Page 143 and 144: Office focus cluster had high expen
Page 145 and 146: especially detailing. This made it
Page 147 and 148: 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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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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Page 527 and 528:
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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