Biomedical Engineering Reference
In-Depth Information
brand level and apply their model to 86 pharmaceutical categories in the US market
for the period 2001-2005. They fi nd that primary demand effects of marketing
promotions are rather small and DTCA is less effective than detailing in driving
primary demand.
Rosenthal et al. ( 2003 ) investigate the effect of DTCA and detailing on drug
sales in fi ve therapeutic classes using monthly aggregate data from August 1996
through December 1999. They fi nd that DTCA has been effective primarily in
expanding the sales of the entire class instead of any individual drug. Using antihis-
tamines as an example, Iizuka and Jin ( 2007 ) show that DTCA has little effect on
the choice of brand despite the massive DTCA expenditure incurred in this class.
Donohue et al. ( 2004 ) analyze claims and benefi ts data for individuals diagnosed
with depression and fi nd a small positive effect that DTCA spending increases the
likelihood of receiving medication treatment, i.e., category expansion effects. They
conjecture this may occur because an individual who is undergoing psychotherapy
for a previous episode of depression may, upon being exposed to DTCA, request
medication treatment in combination with or in lieu of behavioral treatment.
By contrast, they found that providing free samples did not increase the likelihood
of a depressed individual receiving medication treatment.
It has been argued that advertising tends to attract patients to the physicians'
offi ce who have less severe affl ictions and may in fact not be good candidates for
medication. Coupled with the survey-based fi nding described previously that physi-
cians sometimes acquiesce to patients' requests for medications even if they are not
clinically appropriate, as long as they don't harm patients, this raises a concern that
DTCA leads to suboptimal use of physician time and drug resources from a societal
point of view.
Thus, it appears from the literature that the category expanding effects of DTCA
are fairly well established, with two caveats. One, the magnitude of the effect is
generally small, and two, the “quality” of patients brought in remains an area for
further exploration. The unique ability of DTCA to drive potential patients to visit
physicians for diagnosis and treatment gives it an edge relative to physician-directed
promotions such as detailing. The brand-switching effects of DTCA are less clear.
21.3.3.2
Health Disparity and DTCA
Another question with signifi cant public policy implications is whether the effects
of DTCA vary across patient subgroups. A robust and well established fi nding in the
social sciences literature is the relationship between socio-economic status (SES)
and health. In general, there are signifi cant disparities in medical testing, treatment
and health outcomes associated with SES. For example, the 1990 National Health
Interview Survey (Piani and Schoenbom 1993 ) found that patients of higher SES
(college educated and white race) reported a higher likelihood of cholesterol
testing.
Since DTCA can be an important form of consumer information about diseases
and pharmaceutical products, it is useful to explore whether the response to DTCA
varies across patients.
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