Skip to main content

Advertisement

SpringerLink
Log in

The Effect of Competing Direct-to-Consumer Advertising Campaigns on the Use of Drugs for Benign Prostatic Hyperplasia: Time Series Analysis

  • Health Policy
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

Direct-to-consumer advertising (DTCA) remains a controversial issue, with concerns that it leads to unnecessary and inappropriate prescribing. Whether DTCA shifts prescribing from first-line (guideline-recommended) therapy to second-line drugs has not been studied.

Objective

The purpose of this study was to determine the impact of sequential DTCA campaigns for two drugs used to treat benign prostatic hyperplasia (BPH): one newer agent, dutasteride (Avodart®), and one older first-line agent, tamsulosin (Flomax®).

Design

Interrupted time series analysis was used to assess the impact of each DTCA campaign using data on consumer “response” from Google Trends and dispensed prescriptions from IMS Health.

Participants

We analyzed data for the United States from January 2003 to December 2007.

Intervention

DTCA for dutasteride and tamsulosin commenced on July, 2005 and April, 2006, respectively.

Main Measures

Monthly Internet search volume (scaled from 0 to 100) for the advertised trade name of each drug and monthly U.S. prescription rates per 1,000 population were analyzed.

Key Results

The dutasteride campaign was associated with an increase in Internet searches for both “Avodart” (level change +31.3 %, 95 % CI: 27.2–35.4) and “Flomax” (level change +8.3 %, 95 % CI: 0.9–15.7), whereas the tamsulosin campaign was associated with increased “Flomax” searches (level change +25.3 %, 95 % CI: 18.7–31.8). The dutasteride campaign was associated with an increase in the prescription of dutasteride (trend = 0.45/month, 95 % CI: 0.33–0.56), but a larger impact was observed with tamsulosin prescriptions (trend = 0.76/month, 95 % CI: 0.02–1.50). Similarly, the tamsulosin campaign was associated with an immediate fourfold increase in the prescribing of tamsulosin (level change +5.76 units, 95 % CI: 1.79–9.72) compared to dutasteride (level change +1.47 units, 95 % CI: 0.79–2.14).

Conclusions

DTCA was associated with the utilization of drugs to treat symptomatic BPH. However, both campaigns were associated with greater increases in the use of the guideline-recommended first-line agent. DTCA campaigns may increase the overall levels of guideline-recommended treatments to a greater extent than the specific advertised agents.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

Abbreviations

DTCA:

Direct-to-consumer advertising

BPH:

Benign prostatic hyperplasia

5ARI:

5-alpha reductase inhibitor

References

  1. Kornfield R, Donohue J, Berndt ER, Alexander GC. Promotion of prescription drugs to consumers and providers, 2001–2010. PLoS One 2013;8(3):e55504.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Wolfe SM. Direct-to-consumer advertising–education or emotion promotion? N Engl J Med 2002;346(7):524–6.

    Article  PubMed  Google Scholar 

  3. Stange KC. Time to ban direct-to-consumer prescription drug marketing. Ann Fam Med 2007;5(2):101–4.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Ross JS, Kravitz RL. Direct-to-Consumer Television Advertising: Time to Turn Off the Tube? J Gen Intern Med 2013;28(7):862–4.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Holmer AF. Direct-to-consumer advertising–strengthening our health care system. N Engl J Med 2002;346(7):526–8.

    Article  PubMed  Google Scholar 

  6. Mintzes B. Advertising of prescription-only medicines to the public: does evidence of benefit counterbalance harm? Annu Rev Public Health 2012;33:259–77.

    Article  PubMed  Google Scholar 

  7. Law MR, Majumdar SR, Soumerai SB. Effect of illicit direct to consumer advertising on use of etanercept, mometasone, and tegaserod in Canada: controlled longitudinal study. BMJ 2008;337(sep02 1):a1055.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Zachry WM III, Shepherd MD, Hinich MJ, Wilson JP, Brown CM, Lawson KA. Relationship between direct-to-consumer advertising and physician diagnosing and prescribing. Am J Health Syst Pharm 2002;59(1):42–9.

    PubMed  Google Scholar 

  9. Dorn SD, Farley JF, Hansen RA, Shah ND, Sandler RS. Direct-to-consumer and physician promotion of tegaserod correlated with physician visits, diagnoses, and prescriptions. Gastroenterology 2009;137(2):518–24, 524.e1–2.

    Article  PubMed Central  PubMed  Google Scholar 

  10. ’t Jong GW, Stricker BHC, Sturkenboom MCJM. Marketing in the lay media and prescriptions of terbinafine in primary care: Dutch cohort study. BMJ 2004;328(7445):931.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Law MR, Soumerai SB, Adams AS, Majumdar SR. Costs and consequences of direct-to-consumer advertising for clopidogrel in Medicaid. Arch Intern Med 2009;169(21):1969–74.

    Article  PubMed  Google Scholar 

  12. Hansen RA, Shaheen NJ, Schommer JC. Factors influencing the shift of patients from one proton pump inhibitor to another: the effect of direct-to-consumer advertising. Clin Ther 2005;27(9):1478–87.

    Article  PubMed  Google Scholar 

  13. Abrams P. New words for old: lower urinary tract symptoms for “prostatism”. BMJ 1994;308(6934):929–30.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  14. Chute CG, Panser LA, Girman CJ, et al. The prevalence of prostatism: a population-based survey of urinary symptoms. J Urol 1993;150(1):85–9.

    CAS  PubMed  Google Scholar 

  15. Kupelian V, Wei JT, O’Leary MP, et al. Prevalence of lower urinary tract symptoms and effect on quality of life in a racially and ethnically diverse random sample: the Boston Area Community Health (BACH) Survey. Arch Intern Med 2006;166(21):2381–7.

    Article  PubMed  Google Scholar 

  16. AUA Practice Guidelines Committee. AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: Diagnosis and treatment recommendations. J Urol 2003;170(2 Pt 1):530–47.

    Google Scholar 

  17. Vaughan ED. Medical management of benign prostatic hyperplasia–are two drugs better than one? N Engl J Med 2003;349(25):2449–51.

    Article  PubMed  Google Scholar 

  18. Roehrborn CG, Schwinn DA. Alpha1-adrenergic receptors and their inhibitors in lower urinary tract symptoms and benign prostatic hyperplasia. J Urol 2004;171(3):1029–35.

    Article  CAS  PubMed  Google Scholar 

  19. Lowe FC. Role of the newer alpha, -adrenergic-receptor antagonists in the treatment of benign prostatic hyperplasia-related lower urinary tract symptoms. Clin Ther 2004;26(11):1701–13.

    Article  CAS  PubMed  Google Scholar 

  20. Nickel JC. Comparison of clinical trials with finasteride and dutasteride. Rev Urol 2004;6 Suppl 9:S31–9.

    PubMed Central  PubMed  Google Scholar 

  21. Abel GA, Chen K, Taback N, Hassett MJ, Schrag D, Weeks JC. Impact of oncology-related direct-to-consumer advertising: association with appropriate and inappropriate prescriptions. Cancer 2013;119(5):1065–72.

    Article  PubMed  Google Scholar 

  22. Ad$pender™ | Kantar Media [Internet]. [cited 2013 Jul 29]; Available from: http://kantarmediana.com/intelligence/products/adspender

  23. Fox S. Health Information Online. Washington, D.C.: 2005.

  24. Fox S. Online Health Search 2006. Washington, D.C.: 2006.

  25. Nielsen NetRatings Search Engine Ratings - Search Engine Watch [Internet]. [cited 2013 Jul 29]; Available from: http://searchenginewatch.com/article/2067079/Nielsen-NetRatings-Search-Engine-Ratings

  26. Google Trends [Internet]. [cited 2013 Jul 29]; Available from: http://www.google.com/trends/explore#cmpt=q

  27. IMS National Prescription Audit™, January 2003–December 2007, IMS Health Incorporated.

  28. Majumdar SR, Almasi EA, Stafford RS. Promotion and prescribing of hormone therapy after report of harm by the Women’s Health Initiative. JAMA 2004;292(16):1983–8.

    Article  CAS  PubMed  Google Scholar 

  29. Jackevicius CA, Tu JV, Ross JS, Ko DT, Carreon D, Krumholz HM. Use of fibrates in the United States and Canada. JAMA 2011;305(12):1217–24.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  30. Wagner A K, Soumerai SB, Zhang F, Ross-Degnan D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 2002;27(4):299–309.

    Article  CAS  PubMed  Google Scholar 

  31. U.S. Census Bureau DID. Population Estimates [Internet]. [cited 2013 Jul 29]; Available from: http://www.census.gov/popest/data/intercensal/national/nat2010.html

  32. Kravitz RL, Epstein RM, Feldman MD, et al. Influence of patients’ requests for direct-to-consumer advertised antidepressants: a randomized controlled trial. JAMA 2005;293(16):1995–2002.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  33. McConnell JD, Roehrborn CG, Bautista OM, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 2003;349(25):2387–98.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Sean Skeldon is supported in part by the CIHR and the Western Regional Training Centre (WRTC) for Health Services Research. Katy Kozhimannil is supported by a grant from the Building Interdisciplinary Research Careers in Women’s Health BIRCWH) program (grant number K12HD055887), with funds from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Office of Research on Women’s Health, and the National Institute on Aging, at the National Institutes of Health, administered by the University of Minnesota Deborah E. Powell Center for Women’s Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Sumit Majumdar holds the Endowed Chair in Patient Health Management (Faculties of Medicine & Dentistry and Pharmacy & Pharmaceutical Sciences, University of Alberta) and receives salary support as a Health Scholar of the Alberta Heritage Foundation for Medical Research and Alberta Innovates - Health Solutions. Michael Law reports grants from the Canadian Institutes of Health Research during the conduct of the study, and personal fees from Health Canada outside the submitted work.

The statements, findings, conclusions, views, and opinions contained and expressed herein are based in part on data obtained under license from the following IMS Health Incorporated information service(s): National Prescription Audit™(January 2003–December 2007) and National Sales Perspectives™(January 2003–December 2007) IMS Health Incorporated. The statements, findings, conclusions, views, and opinions are not necessarily those of IMS Health Incorporated or any of its affiliated or subsidiary entities.

Conflict of interest

The authors each declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. The Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada

    Sean C. Skeldon MD & Michael R. Law PhD

  2. Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada

    Sean C. Skeldon MD

  3. Department of Urological Sciences, The University of British Columbia, Vancouver, BC, Canada

    Sean C. Skeldon MD

  4. Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA

    Katy B. Kozhimannil PhD

  5. Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada

    Sumit R. Majumdar MD, MPH

Authors
  1. Sean C. Skeldon MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katy B. Kozhimannil PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sumit R. Majumdar MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael R. Law PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sean C. Skeldon MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Skeldon, S.C., Kozhimannil, K.B., Majumdar, S.R. et al. The Effect of Competing Direct-to-Consumer Advertising Campaigns on the Use of Drugs for Benign Prostatic Hyperplasia: Time Series Analysis. J GEN INTERN MED 30, 514–520 (2015). https://doi.org/10.1007/s11606-014-3063-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-014-3063-y

Keywords

Search

Navigation