Assessing concordance of financial conflicts of interest disclosures with payments' databases: a systematic survey of the health literature

Axial spondyloarthritis guidelines - aiming for maximum impact

PURPOSE OF REVIEW

This review discusses international clinical practice guidelines (CPGs) for axial spondyloarthritis (axSpA) focusing on methodology, guideline quality, and implementation.

RECENT FINDINGS

The Assessment of SpondyloArthritis International Society/European Alliance of Associations for Rheumatology (ASAS/EULAR) and Pan-American League of Associations for Rheumatology (PANLAR) recently published axSpA CPGs and updates of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network (ACR/SAA/SPARTAN) and Asia-Pacific League of Associations for Rheumatology (APLAR) CPGs are expected. GRADE has emerged as the dominant framework for CPG development and has been used by three of the four international axSpA guidelines. Notable differences exist among these guidelines in the way that the recommendations are presented. Two of the four acknowledge the need for implementation strategies, but little detail about this is provided. The few studies that have evaluated the implementation of axSpA CPGs have identified poor adherence to recommendations on physical therapy/exercise and disease activity monitoring. Implementation science has identified many barriers and facilitators affecting guideline uptake, including those related to healthcare professionals and to the guidelines themselves. Creation of a tailored implementation plan simultaneously with the CPG is recommended.

SUMMARY

While methodological rigor in the creation of evidence-based recommendations is the focus of CPG development, recommendations must be presented in a user-friendly format that makes them easy to apply. 'Living guidelines' could facilitate keeping content up to date. Implementation is critical for the success of a CPG and should be emphasized in future axSpA guideline updates. Further research is needed to better understand the factors impacting the successful implementation of axSpA CPGs.

Reporting Conflicts of Interest and Funding in Health Care Guidelines: The RIGHT-COI&F Checklist

BACKGROUND

Conflicts of interest (COIs) of contributors to a guideline project and the funding of that project can influence the development of the guideline. Comprehensive reporting of information on COIs and funding is essential for the transparency and credibility of guidelines.

OBJECTIVE

To develop an extension of the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement for the reporting of COIs and funding in policy documents of guideline organizations and in guidelines: the RIGHT-COI&F checklist.

DESIGN

The recommendations of the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network were followed. The process consisted of registration of the project and setting up working groups, generation of the initial list of items, achieving consensus on the items, and formulating and testing the final checklist.

SETTING

International collaboration.

PARTICIPANTS

44 experts.

MEASUREMENTS

Consensus on checklist items.

RESULTS

The checklist contains 27 items: 18 about the COIs of contributors and 9 about the funding of the guideline project. Of the 27 items, 16 are labeled as policy related because they address the reporting of COI and funding policies that apply across an organization's guideline projects. These items should be described ideally in the organization's policy documents, otherwise in the specific guideline. The remaining 11 items are labeled as implementation related and they address the reporting of COIs and funding of the specific guideline.

LIMITATION

The RIGHT-COI&F checklist requires testing in real-life use.

CONCLUSION

The RIGHT-COI&F checklist can be used to guide the reporting of COIs and funding in guideline development and to assess the completeness of reporting in published guidelines and policy documents.

PRIMARY FUNDING SOURCE

The Fundamental Research Funds for the Central Universities of China.

Pharmaceutical industry payments to NHS trusts in England: A four-year analysis of the Disclosure UK database

INTRODUCTION

Although hospitals are key health service providers, their financial ties to drug companies are little understood. We examine non-research pharmaceutical industry payments to English National Health Service (NHS) trusts-hospital groupings providing secondary and tertiary care.

METHODS

We extracted data from the industry-run Disclosure UK database, analysing it descriptively and using the Jonckheere-Terpstra test to establish whether a statistically significant time trend existed in the median values of individual payments. We explained payment value and number per trust with random effects models, using selected trust characteristics as predictors.

RESULTS

Drug companies reported paying £60,253,421 to 234 trusts, representing between 90.0% and 92.0% of all trusts in England between 2015 and 2018. As a share of payments to all healthcare organisations, the number of payments rose from 38.6% to 39.5%, but their value dropped from 33.0% to 23.6%. The number of payments for fees for service and consultancy and contributions to costs of events increased by 61.5% and 29.4%. The median payment value decreased significantly for trusts overall (from £2,250.8 to £1,758.5), including those with lower autonomy from central government; providing acute services; and from half of England's regions. The random effects model showed that acute trusts received significantly more money on average than trusts with all other service profiles; and trusts from East England received significantly less than those from London. However, trusts enjoying greater autonomy from government did not receive significantly more money than others. Trusts also received significantly less money in 2018 than in 2015.

CONCLUSION

NHS trusts had extensive pharmaceutical industry ties but were losing importance as payment targets relative to other healthcare organisations. Industry payment strategies shifted towards events sponsorship, consultancies, and smaller payments. Trusts with specific service and geographical profiles were prioritised. Understanding corporate payments across the health system requires more granular disclosure data.

A structured approach to information retrieval improved identification of funding and researchers' conflicts of interest in trials included in Cochrane reviews

OBJECTIVES

To compare the contemporary Cochrane review approach for retrieving information on trial funding and researchers' conflicts of interest with a structured approach for information retrieval.

STUDY DESIGN AND SETTING

Methodological study of 100 Cochrane reviews from August to December 2020 and one randomly selected trial from each review. Reporting of trial funding and researchers' conflicts of interest in reviews was compared with information identified using a structured retrieval process, and time to retrieve information was noted. We also formulated a guide to systematic reviewers for efficient information retrieval.

RESULTS

Sixty-eight of 100 Cochrane reviews reported trial funding and 24 reported trial researchers' conflicts of interest. A simple structured approach, searching only trial publications (including conflicts of interest disclosure forms), identified funding for 16 additional trials and conflicts of interest information for 39 additional trials. A comprehensive structured approach, searching multiple information sources, identified funding for two additional trials and conflicts of interest for 14 additional trials. The median time to retrieve information was 10 minutes per trial (interquartile range: 7-15) for the simple approach and 20 minutes (11-43) for the comprehensive approach.

CONCLUSION

A structured information retrieval approach improves identification of funding and researchers' conflicts of interest in trials included in Cochrane reviews.

Smoke and mirrors? Conflict of interest declarations in tobacco and e-cigarette-related academic publications

OBJECTIVE

This research explored international tobacco control experts' level of satisfaction with conflict of interest (COI) declaration processes; and the transparency of COI declarations of identified authors publishing in the tobacco, e-cigarette, and related novel products academic literature.

METHODS

This case study profiled 10 authors' (identified by expert panel) COIs pertaining to the tobacco industry; identified the 10 authors' publications (2010-2021); and assessed the transparency of the COI declarations within the publications.

RESULTS

All authors received indirect or direct funding from the tobacco industry. On review of the authors' 553 publications, 61% of COI and funding declarations were accessible, 33% were partially accessible and 6% were inaccessible. Overall, 33% of authors provided complete COI declarations, 51% provided incomplete declarations, and 16% provided no declaration.

CONCLUSION

This research demonstrates existing guidelines and recommendations for reporting COI declarations are not sufficiently robust to ensure transparency in reporting of COI declarations within the field.

IMPLICATIONS FOR PUBLIC HEALTH

Research outcomes have the potential to define public health discourse and influence public opinion, practices, and policy. It is critical that research remains independent and protected from the influence of the tobacco industry. Processes for monitoring and enforcing accurate reporting of COI declarations are needed.

A framework is proposed for defining, categorizing, and assessing conflicts of interest in health research

OBJECTIVE

We propose an operational definition of conflicts of interest (COI), a framework for categorizing interests, and an approach to assessing whether an interest qualifies as a COI.

STUDY DESIGN AND SETTING

We reviewed the literature and conducted methodological studies to inform the development of a draft framework for classifying interests.

RESULTS

We developed the following operational definition: "a conflict of interest exists when a past, current, or expected interest creates a significant risk of inappropriately influencing an individual's judgment, decision, or action when carrying out a specific duty". Interest refers to a benefit (e.g., money received from industry) or to an attribute of the individual (e.g., having specific religious beliefs). The proposed framework includes seven types of interests relating to individuals (direct financial benefit, benefit through professional status, intellectual, and personal) or their institution (direct financial benefit to the institution, benefit through increasing services provided by the institution, and nonfinancial). When assessing whether an interest qualifies as a COI, one could consider its relevance, nature (e.g., cash vs. educational support), magnitude, and recency.

CONCLUSION

The proposed operational definition and categorization framework may help journals, guideline organizations, professional societies, and healthcare institutions enhance transparency in health research.

Accessibility and quality of drug company disclosures of payments to healthcare professionals and organisations in 37 countries: a European policy review

OBJECTIVES

To examine the accessibility and quality of drug company payment data in Europe.

DESIGN

Comparative policy review of payment data in countries with different regulatory approaches to disclosure.

SETTING

37 European countries.

PARTICIPANTS

European Federation of Pharmaceutical Industries and Associations, its trade group and their drug company members; eurosfordocs.eu, an independent database integrating payments disclosed by companies and trade groups; regulatory bodies overseeing payment disclosure.

MAIN OUTCOME MEASURES

Regulatory approaches to disclosure (self-regulation, public regulation, combination of the two); data accessibility (format, structure, searchability, customisable summary statistics, downloadability) and quality (spectrum of disclosed characteristics, payment aggregation, inclusion of taxes, recipient or donor identifiers).

RESULTS

Of 30 countries with self-regulation, five had centralised databases, with Disclosure UK displaying the highest accessibility and quality. In 23 of the remaining countries with self-regulation and available data, disclosures were published in the portable document format (PDF) on individual company websites, preventing the public from understanding payment patterns. Eurosfordocs.eu had greater accessibility than any industry-run database, but the match between the value of payments integrated in eurosfordocs.eu and summarised separately by industry in seven countries ranged between 56% and 100% depending on country. Eurosfordocs.eu shared quality shortcomings with the underlying industry data, including ambiguities in identifying payments and their recipients. Public regulation was found in 15 countries, used either alone (3), in combination (4) or in parallel with (8) self-regulation. Of these countries, 13 established centralised databases with widely ranging accessibility and quality, and sharing some shortcomings with the industry-run databases. The French database, Transparence Santé, had the highest accessibility and quality, exceeding that of Disclosure UK.

CONCLUSIONS

The accessibility and quality of payment data disclosed in European countries are typically low, hindering investigation of financial conflicts of interest. Some improvements are straightforward but reaching the standards characterising the widely researched US Open Payments database requires major regulatory change.

Potential Bias in Image-Guided Procedure Research: A Retrospective Analysis of Disclosed Conflicts of Interest and Open Payment Records

PURPOSE

To assess the prevalence of positive conflict of interest (COI) disclosures in U.S.-based interventional radiology (IR) research as well as the level of agreement between disclosed financial relationships and open payment data for top-cited image-guided procedure research.

MATERIALS AND METHODS

All publications in volume 30 (2019) of the Journal of Vascular and Interventional Radiology (JVIR) were reviewed to estimate the prevalence of COI disclosures in IR research. Publications were categorized as primary research, systematic review, or other. Prevalence was then compared across JVIR publication subtype, categories, and whether they were device-focused with chi-squared tests. Additionally, the Web of Science database was searched for the top 10 cited studies of 10 common image-guided procedures with available U.S. physician payment data. Payments were categorized as historical (>1 year prior to publication) or active (<1 year prior to publication) and compared to disclosed financial COIs with one-way ANOVA.

RESULTS

Positive COI disclosures were present in 29% (114 of 397) of publications in JVIR volume 30. Positive COI disclosures were most prevalent in Standards of Practice (50%, p = 0.01) and more prevalent in device-focused publications (54% vs 23%, p < 0.01). Among the 396 authors of 100 U.S.-based top-cited image-guided procedure publications, 383 (97%) failed to disclose at least one active financial relationship, with an average of $57,937 in undisclosed payments per publication.

CONCLUSION

Conflicts of interest are prevalent in IR, like other areas of healthcare research, and conflicts of interest in top-cited image-guided procedure research are often underreported.

Combining meta-epidemiological study datasets on commercial funding of randomised clinical trials: Database, methods, and descriptive results of the COMFIT study

Randomised trials are often funded by commercial companies and methodological studies support a widely held suspicion that commercial funding may influence trial results and conclusions. However, these studies often have a risk of confounding and reporting bias. The risk of confounding is markedly reduced in meta-epidemiological studies that compare fairly similar trials within meta-analyses, and risk of reporting bias is reduced with access to unpublished data. Therefore, we initiated the COMmercial Funding In Trials (COMFIT) study aimed at investigating the impact of commercial funding on estimated intervention effects in randomised clinical trials based on a consortium of researchers who agreed to share meta-epidemiological study datasets with information on meta-analyses and trials included in meta-epidemiological studies. Here, we describe the COMFIT study, its database, and descriptive results. We included meta-epidemiological studies with published or unpublished data on trial funding source and results or conclusions. We searched five bibliographic databases and other sources. We invited authors of eligible meta-epidemiological studies to join the COMFIT consortium and to share data. The final construction of the COMFIT database involves checking data quality, identifying trial references, harmonising variable categories, and removing non-informative meta-analyses as well as correlated meta-analyses and trial results. We included data from 17 meta-epidemiological studies, covering 728 meta-analyses and 6841 trials. Seven studies (405 meta-analyses, 3272 trials) had not published analyses on the impact of commercial funding, but shared unpublished data on funding source. On this basis, we initiated the construction of a combined database. Once completed, the database will enable comprehensive analyses of the impact of commercial funding on trial results and conclusions with increased statistical power and a markedly reduced risk of confounding and reporting bias.