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Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review

PLoS medicine, 2010-10, Vol.7 (10), p.e1000352-e1000352 [Peer Reviewed Journal]

COPYRIGHT 2010 Public Library of Science ;COPYRIGHT 2010 Public Library of Science ;Spurling et al. 2010 ;2010 Spurling et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Spurling GK, Mansfield PR, Montgomery BD, Lexchin J, Doust J, et al. (2010) Information from Pharmaceutical Companies and the Quality, Quantity, and Cost of Physicians' Prescribing: A Systematic Review. PLoS Med 7(10): e1000352. doi:10.1371/journal.pmed.1000352 ;ISSN: 1549-1676 ;ISSN: 1549-1277 ;EISSN: 1549-1676 ;DOI: 10.1371/journal.pmed.1000352 ;PMID: 20976098

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  • Title:
    Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review
  • Author: Spurling, Geoffrey K ; Mansfield, Peter R ; Montgomery, Brett D ; Lexchin, Joel ; Doust, Jenny ; Othman, Noordin ; Vitry, Agnes I
  • Henry, David
  • Subjects: Advertising ; Confidence intervals ; Consumer advertising ; Cost reduction ; Cost-Benefit Analysis ; Disclosure ; Drug Industry ; Drug Prescriptions - economics ; Drug Prescriptions - standards ; Economic aspects ; Evidence-Based Healthcare/Clinical Decision-Making ; Evidence-Based Healthcare/Quality and Safety in Medical Practice ; Health Care Costs ; Humans ; Influence ; Meetings ; Methods ; Non-Clinical Medicine/Bioethics ; Non-Clinical Medicine/Health Economics ; Non-Clinical Medicine/Health Policy ; Non-Clinical Medicine/Medical Journals ; Pharmaceutical industry ; Practice Patterns, Physicians' - economics ; Practice Patterns, Physicians' - ethics ; Practice Patterns, Physicians' - standards ; Prescription drugs ; Prescription writing ; Quality of Health Care ; Sales promotions ; Sensitivity analysis ; Studies ; Translations ; United States
  • Is Part Of: PLoS medicine, 2010-10, Vol.7 (10), p.e1000352-e1000352
  • Description: Pharmaceutical companies spent $57.5 billion on pharmaceutical promotion in the United States in 2004. The industry claims that promotion provides scientific and educational information to physicians. While some evidence indicates that promotion may adversely influence prescribing, physicians hold a wide range of views about pharmaceutical promotion. The objective of this review is to examine the relationship between exposure to information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing. We searched for studies of physicians with prescribing rights who were exposed to information from pharmaceutical companies (promotional or otherwise). Exposures included pharmaceutical sales representative visits, journal advertisements, attendance at pharmaceutical sponsored meetings, mailed information, prescribing software, and participation in sponsored clinical trials. The outcomes measured were quality, quantity, and cost of physicians' prescribing. We searched Medline (1966 to February 2008), International Pharmaceutical Abstracts (1970 to February 2008), Embase (1997 to February 2008), Current Contents (2001 to 2008), and Central (The Cochrane Library Issue 3, 2007) using the search terms developed with an expert librarian. Additionally, we reviewed reference lists and contacted experts and pharmaceutical companies for information. Randomized and observational studies evaluating information from pharmaceutical companies and measures of physicians' prescribing were independently appraised for methodological quality by two authors. Studies were excluded where insufficient study information precluded appraisal. The full text of 255 articles was retrieved from electronic databases (7,185 studies) and other sources (138 studies). Articles were then excluded because they did not fulfil inclusion criteria (179) or quality appraisal criteria (18), leaving 58 included studies with 87 distinct analyses. Data were extracted independently by two authors and a narrative synthesis performed following the MOOSE guidelines. Of the set of studies examining prescribing quality outcomes, five found associations between exposure to pharmaceutical company information and lower quality prescribing, four did not detect an association, and one found associations with lower and higher quality prescribing. 38 included studies found associations between exposure and higher frequency of prescribing and 13 did not detect an association. Five included studies found evidence for association with higher costs, four found no association, and one found an association with lower costs. The narrative synthesis finding of variable results was supported by a meta-analysis of studies of prescribing frequency that found significant heterogeneity. The observational nature of most included studies is the main limitation of this review. With rare exceptions, studies of exposure to information provided directly by pharmaceutical companies have found associations with higher prescribing frequency, higher costs, or lower prescribing quality or have not found significant associations. We did not find evidence of net improvements in prescribing, but the available literature does not exclude the possibility that prescribing may sometimes be improved. Still, we recommend that practitioners follow the precautionary principle and thus avoid exposure to information from pharmaceutical companies. Please see later in the article for the Editors' Summary.
  • Publisher: United States: Public Library of Science
  • Language: English
  • Identifier: ISSN: 1549-1676
    ISSN: 1549-1277
    EISSN: 1549-1676
    DOI: 10.1371/journal.pmed.1000352
    PMID: 20976098
  • Source: Freely Accessible Journals
    Open Access: PubMed Central
    PLoS (Open access)
    AUTh Library subscriptions: ProQuest Central
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