In a retrospective study of prescribing patterns among thousands of American ophthalmologists and optometrists, Johns Hopkins Medicine researchers concluded that ophthalmologists who receive even small financial incentives from drug companies, such as free food, sponsored trips for attending meetings or consulting fees, they may be twice as likely to prescribe company-brand eye drops for glaucoma rather than cheaper generic versions.
“We don’t know why certain doctors more often prescribe high-cost brand-name eye drops when generics are generally just as good,” says Thomas Johnson III, MD, Ph.D., Allan and Shelley Holt Rising Professor of ‘Ophthalmology at Johns Hopkins. University School of Medicine and Wilmer Eye Institute, which notes that the study was not designed to answer that question. “Perhaps frequent exposure to positive messages about a drug influences this tendency, or prescribers feel compelled, consciously or unconsciously, to demonstrate collegiality with pharmaceutical sales representatives.”
Other studies have shown that the contributions of pharmaceutical companies -; big and small—they influence a wide range of treatment decisions, including the options for eye injections for macular degeneration, an age-related eye disease.
The focus of the newly reported study was on glaucoma drops widely prescribed to reduce eye pressure and fluid buildup and stop the blinding eye disease from getting worse. More than 3 million Americans have the disorder, according to the US Centers for Disease Control and Prevention. The drops are available in both generic and brand-name versions and have similar side effects. Generic versions are about half the cost of brand-name versions and are just as effective, researchers say.
The study, described July 28 in JAMA Ophthalmology, was designed to assess the association between receiving financial incentives from drug companies and practitioners’ choices to prescribe brand-name versus generic glaucoma drops. The median annual amount paid to study group recipients in 2018 was $65 (range: $24 to $147).
For the study, researchers examined payment claims from the Centers for Medicare and Medicaid Services to find 26,038 vision care professionals who prescribed glaucoma eye drops in 2018. The group included 7,449 women and 18,589 male vision professionals. About 5,426 were optometrists and 20,612 were ophthalmologists, including 1,103 glaucoma specialists.
Most of the group (21,438) practiced in urban localities.
On average, practitioners prescribed 1,778 days of glaucoma eye drops during the study period. About 16,353 prescribers (63%) did not receive payments from the brand eye drop manufacturers.
During the study period, the drug manufacturers spent $5,060,346 in payments to the professionals who were part of the study, and 92% of those funds were spent on only 25% of the participants.
Among the study group, 4,559 did not receive a branded eye drop. About 17,480 practitioners prescribed branded eye drops, but less than half the time. Another 3,999 practitioners prescribed branded eye drops more than half the time.
After further statistical analysis, the researchers concluded that practitioners who received any amount of payment from the drug company were 1.8 times more likely than practitioners who did not receive payment to prescribe more brand eye drops half the time
Prescribers who received the most payments -; in the first 25% of recipients -; were twice as likely to prescribe branded eye drops as non-paid practitioners.
The link between payments and prescription of brand-name drops remained strong, the researchers say, even when the top 5% and 1% of practitioners who received payments were excluded. This suggests that the link is not driven by a few “outlier” prescribers who received the most payments, the researchers say.
Prescriber gender, urban location, and glaucoma specialty status were not associated with a higher frequency of brand eye drop prescriptions.
While some vision care professionals may say that small payments will not influence their prescribing behavior, these data suggest otherwise.”
Study co-author Gerard Anderson, Ph.D., professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health
Funding for the research was provided by the Johns Hopkins University School of Medicine, the National Eye Institute of the National Institutes of Health (K08EY031801), the Johns Hopkins Wilmer Eye Institute, the Allan and Shelley Holt Rising Professorship and Arnold Ventures.
Andrew Nguyen of Johns Hopkins and Kelly Anderson of the University of Colorado contributed to the statistical analysis and writing of this research.
Johnson has received non-financial support from Icare USA and grants from Perfuse Therapeutics and Injectsense.
Nguyen, AM, et al. (2022) Association between open payments: reported industry value transfers and prostaglandin analogue prescribing in the US. JAMA Ophthalmology. doi.org/10.1001/jamaophthalmol.2022.2757.