Industry Relationships With Medical Oncologists: Who Are the High-Payment Physicians?

PURPOSE: Many oncologists have relationships with industry. Previous work has shown that these payments are usually modest; however, there exist a subset of medical oncologists who receive more than $100,000 US dollars (USD) annually. Here, we describe the characteristics of these physicians. METHODS: This retrospective cohort study used the Open Payments data set to identify all US-based medical oncologists/hematologists who received $100,000+ USD in general payments linked to cancer medications in 2018. Open Payments and a web-based search were used to identify physician characteristics, demographics, research profile, and leadership positions. RESULTS: One hundred thirty-nine medical oncologists received > $100,000 USD in general payments. The median payment was $154,613 USD, and the total payment was $24.2 million USD. These high-payment physicians represent 1% of all US medical oncologists (N = 10,620) yet account for 37% of all industry payments in 2018. Sixty percent (84 of 139) and 21% (29 of 139) of these high-payment physicians hold hospital and specialty association leadership roles, respectively. One quarter (24%, 33 of 139) serve on journal editorial boards, and 10% (14 of 139) have authored clinical practice guidelines; 72% (100 of 139) hold faculty appointments. CONCLUSION: A small number of medical oncologists receive very high payments from the pharmaceutical industry. These physicians hold major leadership roles within oncology. Further work is needed to understand the extent to which these conflicts of interest may shape clinical practice and policy.

Trends in drug revenue among major pharmaceutical companies: A 2010-2019 cohort study.

BACKGROUND: Over the past 2 decades there has been a substantial increase in the number of new cancer medicines; this has been accompanied by a dramatic rise in drug costs. It is unknown how these trends impact the revenue of the pharmaceutical sector. METHODS: Retrospective cohort study to characterize temporal trends of revenue generated from cancer medicines as a proportion of total drug revenue among 10 large pharmaceutical companies from 2010 to 2019. Itemized product-sales data publicly available through company websites or annual filings were used to identify annual drug revenue. Revenue data were adjusted for inflation and converted to 2019 US dollars. RESULTS: During the study period, cumulative annual revenue generated from cancer drugs increased by 70%: from $55.8 billion to $95.1 billion, while cumulative revenue from nononcology drugs decreased 18%: from $342.2 billion to $281.5 billion. The proportion of total drug revenue generated from oncology drugs increased substantially over the study period: from 14% in 2010 to 25% in 2019 (τ = 1.0, P < .001). CONCLUSIONS: Among 10 of the world's largest pharmaceutical companies, revenues generated from the sale of cancer drugs have increased by 70% over the past decade, while revenues from other medicines have decreased by 18%. Revenues from cancer drugs now account for one-quarter of the net revenues from these companies. Further work is needed to understand if this increase in sales revenue reflects industry profit, and to what extent increased spending has translated into improvements in patient and population outcomes.

Evaluation of the Clinical Benefit of Cancer Drugs Submitted for Reimbursement Recommendation Decisions in Canada.

Importance: Cancer drugs approved by the US Food and Drug Administration have come under scrutiny for marginal clinical benefits; however, the clinical benefits of cancer drugs recommended for reimbursement in Canada have not been adequately studied. Objective: To assess the differences in the clinical evidence and benefit of cancer drugs that received a positive vs a negative recommendation for provincial reimbursement in Canada. Design, Setting, and Participants: This cohort study obtained publicly available regulatory documents from the pan-Canadian Oncology Drug Review (pCODR) and corresponding clinical trial documentation. All cancer drugs with a solid tumor indication that were submitted from the inception of the pCODR (July 2011) to February 2020 were evaluated. To be included, submissions had to have a final reimbursement recommendation; submissions that were incomplete, were withdrawn, or had a pending decision were excluded. Exposures: A completed reimbursement recommendation decision from the pCODR. Main Outcomes and Measures: Final reimbursement recommendation (positive vs negative); trial characteristics; and relevant clinical outcomes (ie, overall survival [OS] and progression-free survival [PFS]), including the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS) scores available at the time of pCODR assessment. Results: Between 2011 and 2020, the pCODR issued 104 reimbursement recommendation decisions for cancer drugs with a solid tumor indication. Among these drug submissions, 78 (75.0%) received a positive recommendation, of which 72 (92.3%) were conditional. Drugs that received a positive recommendation compared with those with a negative recommendation were more likely to have phase 3 randomized clinical trial design (92.3% [72 of 78] vs 53.8% [14 of 26]; P < .001) and have substantial benefit according to the ESMO-MCBS scores (61.5% [48 of 78] vs 19.2% [5 of 26]; P < .001). The most common primary end points associated with the successful submissions were PFS (53.9%) and OS (32.1%). Overall, 39 of 78 submissions (50.0%) that received a positive recommendation had shown OS benefit, with median (interquartile range) OS gains of 3.7 (2.7-6.5) months. Conclusions and Relevance: This cohort study found that, although the pCODR takes into account the magnitude of clinical benefit, only half of the cancer drugs that received a positive recommendation had evidence of improved OS and the survival gains were usually modest. These results suggest that, although the pCODR helps filter out some cancer drugs with low quality of evidence and low magnitude of benefit, cancer drugs without meaningful patient benefit continue to enter the Canadian market; these findings are important for making reimbursement policy decisions globally.

Industry payments to US physicians for cancer therapeutics: An analysis of the 2016-2018 open payments datasets.

BACKGROUND: Many oncologists who lead guidelines and clinical trials have financial conflicts of interest (fCOI) with industry. However, the extent to which fCOI reaches all cancer care providers is not known. Here we describe industry payments across all cancer care specialties by specific drug. METHODS: This observational, retrospective cohort study used Open Payments to describe general payments (i.e. consulting fees, meals, travel) to all US physicians for any cancer medicine during 2016-2018. Endpoints included number and value of payments by specialty, drug, and year. RESULTS: During 2016-2018, industry made general payments to 52 441 physicians for 137 unique cancer drugs. Annual number of payments (465 655 in 2018) and total value ($98.5 million in 2018) increased over the study period (20 % and 31 % increase since 2016). Medical/hematologic oncologists, surgical oncologists and radiologists received the highest total value of payments, accounting for $65.7 million (67 % of total), $13.4 million (14 % of total) and $10.8 million (11 % of total) in 2018. In 2018, 5 % of physicians (n = 1660) received >$10 000 in annual payments and 0.6 % (n = 209) received >$100 000. Pembrolizumab and Nivolumab, were associated with the highest total payment in each year, accounting for 12 % and 6 % (2018) of total value, respectively. CONCLUSIONS: While prior work has identified fCOIs among oncology leaders, these data suggest that payments extend across the cancer system. POLICY SUMMARY: Pre-existing data suggest a strong relationship between industry payments and physician prescribing. The current study demonstrates that fCOIs among oncology prescribers are pervasive. The oncology community must consider the extent to which these relationships influence clinical practice and regulatory policies.

Characterizing the Effects of Extreme Cold Using Real-time Syndromic Surveillance, Ontario, Canada, 2010-2016.

Morbidity and mortality from exposure to extreme cold highlight the need for meaningful temperature thresholds to activate public health alerts. We analyzed emergency department (ED) records for cold temperature-related visits collected by the Acute Care Enhanced Surveillance system-a syndromic surveillance system that captures data on ED visits from hospitals in Ontario-for geographic trends related to ambient winter temperature. We used 3 Early Aberration Reporting System algorithms of increasing sensitivity-C1, C2, and C3-to determine the temperature at which anomalous counts of cold temperature-related ED visits occurred in northern and southern Ontario from 2010 to 2016. The C2 algorithm was the most sensitive detection method. Results showed lower threshold temperatures for Acute Care Enhanced Surveillance alerts in northern Ontario than in southern Ontario. Public health alerts for cold temperature warnings that are based on cold temperature-related ED visit counts and ambient temperature may improve the accuracy of public warnings about cold temperature risks.