Payments from the pharmaceutical industry are associated with oncologists’ prescribing of cancer drugs of questionable benefit, according to a cohort study of fee-for-service Medicare claims. “These findings raise quality of care concerns about the financial relationships between physicians and industry,” the authors conclude.
Claims from 2014 to 2019 for beneficiaries with incident cancer were evaluated for any of 4 nonrecommended or low-value interventions: denosumab for castration-sensitive prostate cancer, granulocyte colony-stimulating factors (GCSF) for patients at low risk for neutropenic fever, nab-paclitaxel for cancers with no evidence of superiority over paclitaxel, and a branded drug in settings where a generic or biosimilar version was available. The primary outcome was the receipt of those drugs, and the primary association was the receipt of drug company monies within the year prior to the use of the drug.
“Oncologists were in receipt of industry payments for 2,962 of 9,799 patients (30.2%) at risk for non-recommended denosumab (median $63), 76,747 of 271,485 patients (28.3%) at risk for GCSF (median $60); 18,491 of 86,394 patients (21.4%) at risk for nab-paclitaxel (median $89), and 4,170 of 13,386 patients (31.2%) at risk for branded drugs (median $156). The unadjusted proportion of patients who received non-recommended denosumab was 31.4% for those whose oncologist had not received payment and 49.5% for those whose oncologist had (prevalence difference 18.0%); the corresponding values for GCSF were 26.6% v32.1% (5.5%), for nab-paclitaxel were 7.3% v 15.1% (7.8%), and for branded drugs were 88.3% v 83.5% (−4.8%). Controlling for patients’ characteristics and calendar year, payments from industry were associated with increased use of denosumab (17.5% (95% confidence interval 15.3% to 19.7%)), GCSF (5.8% (5.4% to 6.1%)), and nab-paclitaxel (7.6% (7.1% to 8.1%)), but lower use of branded drugs (−4.6% (−5.8% to −3.3%)). In physician level indicator models, payments from industry were associated with increased use of denosumab (7.4% (2.5% to 12.2%)) and nab-paclitaxel (1.7% (0.9% to 2.5%)), but not with GCSF (0.4% (−0.3% to 1.1%)) or branded drugs (1.2% (−6.0 to 8.5%)).”