تاثیر تبلیغات مستقیم به مصرف کنندگان داروهای تجویزی بر ویزیت پزشک و درخواست دارو : یافته های تجربی و پیامدهای سیاست عمومی

This study analyzes the effect of DTCA expenditures for anti-hyperlipidemia drugs on patient behaviors. The key findings are: (a) DTCA expenditures have a positive and long-term effect on the number of visits to physicians by newly diagnosed hyperlipidemia patients. (b) The effectiveness of DTCA in generating new patient visits varies substantially across patient sub-groups. (c) The effect of DTCA is larger on drug visits than on non-drug-only visits. (d) Own-brand DTCA expenditures increase the number of patient requests for Lipitor and Zocor, but have no effect on patient requests for Pravachol. Competing drugs’ DTCA expenditures have a positive effect only on patient requests for the leading brand, Lipitor. (e) A cost-effectiveness analysis suggests that the economic benefits of DTCA in terms of life years saved by preventing cardiovascular disease are considerably larger than the costs of advertising. (f) DTCA on TV has strong effects on underserved segments of the population, such as those on Medicaid. We believe this finding should be carefully considered by proponents of a complete ban or stricter regulations on DTCA.

Direct-to-consumer advertising (DTCA) by pharmaceutical companies has always been a controversial public policy issue in the US and New Zealand, the only two developed countries where it is fully allowed. The issue has also been hotly debated in the European Union, Canada and Australia, where regulatory changes to lift current restrictions are being actively considered or have been considered. In August 1997, the U.S. Food and Drug Administration (FDA) revised its rules on Direct-to-Consumer Advertising (DTCA) for prescription drugs and allowed pharmaceutical firms to use DTCA containing both the brand name and medical claims without the “brief summary" of drug effectiveness, side effects, and contraindications that had previously been required. The FDA clarification effectively opened up mass media such as TV and radio to DTCA, which was mainly limited to print media prior to 1997. Following the clarification, DTCA expenditure for prescription drugs in the U.S. grew explosively, from $1.1 billion in 1997 to $4.8 billion in 2007 (IMS Health, 2007). New Zealand experienced similar growth in DTCA from its beginning circa 1995, during which there were unsuccessful attempts to change the liberal legislation on DTCA. Stremersch and Lemmens (2009) believe that sales of pharmaceutical drugs are hurt in markets that forbid DTCA, and this effect is stronger for new drugs than for mature drugs. In the European Union, a 5-year pilot project allowing DTCA for AIDS, asthma and diabetes was proposed by the European Commission, but it was rejected by the European Parliament in 2003. Despite this decision, pharmaceutical companies, media industries and the European Commission have continued to push for watering down this strict ban on DTCA in the European Union.

Our study has examined the impact of DTCA on newly diagnosed patient visits to physicians and on the number of patient requests for advertised statin drugs. We also study how the effects of DTCA on visits vary across patient sub-groups based on insurance status. Finally, we analyze the cost-effectiveness of DTCA in saving hyperlipidemia patients’ lives. In our empirical analysis, we discover the following: (a) DTCA expenditure has a positive and long-term effect on physician visits by newly diagnosed patients. At the average DTCA level, every $221 increase in DTCA eventually leads to one more newly diagnosed patient visit. (b) DTCA's effectiveness in generating new patient visits to physicians varies substantially across patient subgroups. Patients on Medicaid and Managed Care plans are very responsive to DTCA, whereas patients covered by Medicare and Indemnity plans are not sensitive to DTCA. (c) The effect of DTCA is larger on drug visits than on non-drug-only visits. (d) DTCA expenditures have a positive effect on requests made by patients for drugs with a larger market share. Competing drugs’ DTCA expenditures have a positive effect on patient requests for the leading brand, Lipitor. (e) Our cost-effectiveness analysis of DTCA shows that the economic benefits of DTCA in terms of the life-years saved by preventing cardiovascular disease are considerably larger than the costs of advertising, even though it has a market share-stealing effect on statin sales. (f) We find that patients on Medicaid respond strongly to DTCA on TV. Because the pharmaceutical industry's response to critics of DTCA has been to shift spending away from TV to print media, this raises the concern that the disparity in access to medical information between patient groups of different SES may grow.