Understanding the Importance of Industry Relationships for Cancer Care Quality, Outcomes, and Costs

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PROJECT SUMMARY Personal payments from the pharmaceutical industry to US physicians are common and influence physician prescribing. Approximately 80% of medical oncologists receive personal payments from industry each year, with a mean of over $5,500 per physician. These payments may result in differences in the quality of cancer care delivery and potentially affect patient outcomes. Because the selection of different cancer treatments directly impacts patient outcomes such as drug toxicity, financial toxicity, and survival, these outcomes may be affected when industry payments cause changes in physicians’ treatment selection. Despite concerns about the potential influence of industry payments on medical practice, no study has investigated whether the changes in treatment patterns resulting from industry payments have consequences for patients. The short- term project goal is to evaluate the association between industry payments and cancer care quality, patient outcomes, and costs. The long-term research goal is to understand the importance of physician-industry financial relationships within the US healthcare system. Our overall hypothesis is that industry payments affect care delivery and, ultimately, patient outcomes. To test this hypothesis, we will link CMS Open Payments data to Medicare fee-for-service claims. The exposure of interest will be receipt of payments by the treating physician from a manufacturer of a drug relevant to each patient’s treatment decision. Aim 1: Assess the association between industry payments and cancer care quality. We will assess whether receipt of industry payments by physicians is associated with the likelihood that they deliver the guideline-preferred treatment for each patient (1A) and established forms of low-value care (1B). We hypothesize that physicians who received payments are less likely to use guideline-preferred treatments (1A) and are more likely to use low-value interventions (1B). Aim 2: Assess the association between industry payments and patient outcomes and costs of care. We will assess whether patients treated by physicians who received industry payments have differences in patient-focused outcomes such as unplanned acute care utilization, survival time, and quality of end-of-life care (2A) and whether they have differences in Medicare spending (2B). We hypothesize that patients treated by physicians who received payments are more likely to have acute care utilization, shorter survival time, and lower quality end-of-life care (2A) and to have increased Medicare spending (2B). This study will be the first to assess the relationship between industry payments and patient- focused outcomes, substantially increasing our understanding of the health system impact of these payments. These results may inform future policy and practice decisions regarding physician-industry interactions, potentially contributing to improvements in cancer care quality, improved patient outcomes, and lower costs.