Direct-to-Consumer Advertising of Pharmaceuticals: An Integrative Review - Innovation and Marketing in the Pharmaceutical Industry - page 631

Differences in response to DTCA across patients arise due to different levels of
exposure to media and advertising, varying levels of need, current diagnosis, and
treatment, and differences in access to and type of health care (for instance, health
insurance). Using data from two nationwide surveys, Gönül et al. ( 2000 ) fi nd that
patients who have an ongoing need for health care, that is, those with children or with a
chronic condition requiring medication, value prescription drug advertising more highly.
Iizuka and Jin ( 2005 ) do not fi nd differences in effectiveness of DTCA in
generating physician visits across patients with different insurance. On the contrary,
Hosken and Wendling ( 2010 ) report that highly educated patients and women, in
particular women with Medicaid insurance, are the most responsive to drug adver-
tising while Hispanics are the least responsive to advertising. Avery et al. ( 2008 )
analyze exposure to advertisements for pharmaceutical products that treat ten
categories of health conditions. They fi nd that some groups, most notably Blacks,
unemployed consumers, those who do not work full-time, as well as consumers
with less schooling and lower incomes are exposed to more DTC advertisements.
Liu and Gupta ( 2011 ) fi nd that the effectiveness of DTCA in generating new patient
visits varies substantially across patients grouped by insurance status. Specifi cally,
they report that while older patients (those on Medicare) and patients on indemnity are
not responsive to DTCA in terms of visits to physicians, poorer patients (those on
Medicaid) and patients on managed care plans are very responsive to DTCA.

21.3.3.3 DTCA Cost Effectiveness

Much of the empirical work on DTCA attempts to address the question of social
usefulness of DTCA by distinguishing between its impacts on expanding the thera-
peutic category vs. changing brand shares. However, even if DTCA expands category
demand, thereby reducing underdiagnosis and under-treatment, the question remains
whether it is a cost-effective instrument for this purpose. Atherly and Rubin ( 2009 )
use published information (i.e., they base their analysis and conclusions on previous
literature) to analyze the economic value of DTCA. They fi nd that DTCA is likely to
be cost effective if the advertised drugs lead to increased demand for treatments that
are themselves cost effective, and if patients driven to the treatment by DTCA are
similar to other patients (those not driven by DTCA). Liu and Gupta ( 2011 ) estimate
the cost effectiveness of DTCA of statins by combining their estimates of the effec-
tiveness of DTCA in driving patients to visit physicians with published information
(drawn from the literature) of the effectiveness of statins in extending patients' life
expectancy and the cost of such treatment. They conclude that DTCA of statins is cost
effective despite several conservative assumptions about the benefi ts of DTCA.

21.3.3.4 Regulation

Worldwide, promotion and distribution of prescription pharmaceuticals is strictly
regulated by government agencies. As noted previously, this is especially true for
DTCA which has been banned in all but 2 of the 34 member countries of the OECD.