Increasing Financial Payments From Industry to Medical Oncologists in the United States, 2014-2017

Awareness of Financial Conflicts of Interest in Selecting Clinical Practice Guidelines Among Nepalese Oncologists: A Cross-Sectional Study

BACKGROUND

Financial conflicts of interest (FCOIs) between pharmaceutical companies and clinical practice guideline (CPG) authors can influence guideline recommendations, posing challenges to patient care. Despite global concerns, limited research exists on FCOI awareness among healthcare professionals in lower-middle-income countries like Nepal.

METHODS

This cross-sectional study, conducted between June 2020 and January 2021, aimed to assess FCOI awareness among Nepalese oncologists and identify associated factors. Data were collected through an online survey of 102 oncologists selected from three medical societies. Descriptive statistics and Fisher's exact tests were used for analysis.

RESULTS

Of the participants, 64 (63%) considered FCOIs between pharmaceutical companies and CPG authors when implementing guidelines. Significant associations were found between FCOI consideration and three factors: type of CPGs used, with higher consideration among users of national (80%) and international guidelines (69%) compared with local guidelines (44%) (p = 0.04); place of medical education, with higher consideration among Nepal-trained physicians (77%) compared with those trained abroad (61%) or both (44%) (p = 0.012); and experience in cancer field, with higher consideration among those with less than 10 years of experience (75%) compared with those having 10-20 years (49%) or more than 20 years (63%) of experience (p = 0.033).

CONCLUSION

While nearly two-thirds of Nepalese oncologists consider FCOIs when implementing CPGs, enhancing awareness among the remaining one-third is crucial. The findings suggest the need for targeted educational programs and stronger FCOI disclosure mechanisms, particularly as Nepal develops its own CPGs.

Trends in enforcement of National Comprehensive Cancer Network financial conflict of interest policy

BACKGROUND

The National Comprehensive Cancer Network (NCCN) financial conflict of interest (FCOI) policy sets dollar maximums for panelists, but violations may occur.

METHODS

We studied NCCN Guidelines panelists for the 20 most prevalent cancers, 2013-2022. We included panelists with at least 1 full calendar year of service ("current panelists") and those who began service during the study period ("new panelists"); NCCN FCOI policy limits ($20 000 from any single company or $50 000 across all companies) apply to both groups. Industry payments were obtained from Open Payments and mapped manually via National Provider Identifier. We calculated industry payments received, excluding the same payment categories as does NCCN (research, meals, travel and lodging). We estimated whether panelists received payments exceeding NCCN limits ("violation"). As a proxy for whether panelists were subsequently disqualified as stipulated, we measured continued service for at least 1 full calendar year ("retention") subsequent to an estimated violation. We analyzed retention before and after 2016, due to increased scrutiny on NCCN FCOI in 2016.

RESULTS

The annual proportion of current panelists with estimated violations ranged between 0.5% (2020) and 5.8% (2016). Among panelists who did vs did not have violations, retention was 83.6% vs 88.5% during 2014-2015 (odds ratio [OR] = 0.55, 95% CI = 0.26 to 1.31) and 46.6% vs 89.4% during 2017-2020 (OR = 0.10, 95% CI = 0.06 to 0.17). Among new panelists, 2.7% (5/185) had prior-year violations during 2014-2015, as did 5.5% (18/330) during 2017-2021.

CONCLUSIONS

Each year, a small portion of panelists receive industry payments exceeding NCCN limits. Since 2016, the likelihood that such panelists will continue to serve has decreased substantially.

Pharmaceutical Industry Payments to Medical Oncologists in the Netherlands: Trends and Patterns Provided by an Open-Access Transparency Data Set

PURPOSE

Health care expenditure related to oncologic treatments is skyrocketing although many treatments offer marginal, if any, clinical benefit. Financial conflicts of interest (fCOI) resulting from pharmaceutical industry (pharma) payments to physicians is increasingly recognized as a predictive factor for regulatory board approval and guideline incorporation of low-value treatments. We sought to study the extent to which pharma payments to medical oncologists occur in the Netherlands, the amount of money involved, and whether these occur more frequently and are higher for key opinion leaders (KOLs).

METHODS

In our cross-sectional retrospective database study, we used several Dutch open-access databases and extracted data registered between 2019 and 2021.

RESULTS

A cumulative amount of €899,863 was paid to 48.8% of the 408 registered medical oncologists. Over time, there was a marked decline in both the proportion of medical oncologists receiving payments (from 40.4% in 2019 to 19.1% in 2021) and the mean annual value of payments (from €2,962 in 2019 to €2,188 in 2021) with the latter mainly resulting from a decline in hospitality-related transactions. KOLs were more likely to receive industry payments and received a higher median payment value.

DISCUSSION

Our findings should contribute to the increasing awareness in the Netherlands of the potential effects of fCOI.

Cancer medicines: a private vice for public benefit?

Cancer medicines have become one of the most dominant global medical technologies. They generate huge profits for the biopharmaceutical industry as well as fuel the research and advocacy activities of public funders, patient organisations, clinical and scientific communities and entire federal political ecosystems. The mismatch between the price, affordability and value of many cancer medicines and global need has generated significant policy debate, yet we see little change in behaviours from any of the major actors from public research funders through to regulatory authorities. In this policy analysis we examine whether, considering the money and power inherent in this system, any rationale global consensus and policy can be achieved to deliver affordable and equitable cancer medicines that consistently deliver clinically meaningful benefit.

Pharmaceutical industry payments and delivery of non-recommended and low value cancer drugs: population based cohort study

OBJECTIVE

To estimate the association between oncologists' receipt of payments from the pharmaceutical industry and delivery of non-recommended or low value interventions among their patients.

DESIGN

Cohort study.

SETTING

Fee-for-service Medicare claims.

PARTICIPANTS

Medicare beneficiaries with a diagnosis of incident cancer (new occurrence of a cancer diagnosis code in proximity to claims for cancer treatment, and no such diagnosis codes during a ≥1 year washout period) during 2014-19, who met additional requirements identifying them as at risk for one of four non-recommended 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.

MAIN OUTCOME MEASURES

Receipt of the non-recommended or low value drug for which the patient was at risk. The primary association of interest was the assigned oncologist's receipt of any general payments from the manufacturer of the corresponding non-recommended or low value drug (measured in Open Payments) within 365 days before the patient's index cancer date. The two modeling approaches used were general linear model controlling for patients' characteristics and calendar year, and general linear model with physician level indicator variables.

RESULTS

Oncologists were in receipt of industry payments for 2962 of 9799 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 4170 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% v 32.1% (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%)).

CONCLUSIONS

Within some clinical scenarios, industry payments to physicians are associated with non-recommended and low value drugs. These findings raise quality of care concerns about the financial relationships between physicians and industry.

Characterizing industry payments to US teaching hospitals and affiliated physicians: a cross-sectional analysis of the Open Payments datasets from 2016 to 2022

Industry payments to US teaching hospitals are common; however, little is known about whether these financial relationships influence affiliated physicians to engage in similar financial relationships with industry. Using national hospital, physician, and industry payment data we investigated trends in industry payments made to US teaching hospitals and affiliated physicians to characterize the magnitude and nature of payments. In addition, we assessed if physicians may be influenced to accept higher value industry payments depending on the value of promotional payments accepted by the teaching hospital they affiliate with. We found that physicians with a US teaching hospital affiliation are associated with accepting higher value industry payments as the total value of industry payments of the teaching hospital increases. Our findings varied by specialty, with surgeons accepting the highest value payments. These results highlight the need for greater public disclosure and awareness of payments to better manage and mitigate industry-biased clinical decision making.