Televised Direct to Consumer Pharmaceutical Advertising and Patient Outcomes

描述（由申请人提供）：制药行业每年花费数十亿美元用于处方药的直接面向消费者广告（DTCA）。由于向公众传递卫生信息的挑战以及可能产生意想不到的后果，因此对直接传播信息的优点一直存在相当大的争论。虽然有几项研究调查了DTCA对消费者行为和健康结果的影响，但大多数研究使用的是总支出，而不是更精确的广告曝光措施，而且大多数研究都量化了DTCA对单一药物或治疗类别的影响。这一点很重要，因为常用广告药物治疗的患者群体、严重程度、慢性程度和症状学存在显著差异，这些差异可能会影响DTCA的效果。此外，很少有调查研究患者或区域卫生系统的特点如何缓和直接面向消费者的广告的影响，但经济学和行为理论都表明，这些因素可能对其效果有重要影响。广告的内容也存在重要的差异，来自健康传播其他领域的工作表明，广告内容影响消费者对健康信息的反应，但很少有分析评估DTCA的质量和执行特征如何影响其效果。我们提出了一系列相互关联的目标，这些目标利用了医疗保健利用数据的独特组合，这些数据来自最大的健康计划保险索赔之一，以及来自尼尔森媒体研究的电视广告曝光措施。我们将使用来自区域资源文件和IMS Health的数据补充此信息，以获得有关广告发生的上下文的信息。我们还将开发和应用一套代码捕捉关键的定性和执行广告的特点。这些数据的结合将使我们能够检验DTCA对医疗保健利用和药品销售的影响，并探索个体特征、情境影响和广告特征对DTCA与利用和销售之间关系的相互作用。我们的团队在广告和健康行为研究以及药物流行病学和药物政策方面具有专业知识，完全有资格进行拟议的研究。我们将使用先进的计量经济学技术，我们的分析将为政策制定者和其他利益相关者提供重要信息，以寻求最佳平衡直接面向消费者的广告的复杂风险和收益。

DESCRIPTION (provided by applicant): The pharmaceutical industry spends billions of dollars each year on direct-to-consumer advertising (DTCA) of prescription drugs. Because of the challenge of conveying health information to the public and the potential for unintended consequences, the merits of DTCA have been subject to considerable debate. Although several studies have examined the effect of DTCA on consumers' behavior and health outcomes, most have used aggregate spending, rather than more refined measures of ad exposure, and most have quantified the impact of DTCA regarding a single drug or therapeutic class. This is important because there are significant differences in the patient population, severity, chronicity, and symptomatology of conditions treated by commonly advertised drugs, and these differences may influence the effect of DTCA. In addition, few investigations have examined how patient or regional health system characteristics moderate the impact of direct-to-consumer advertising, yet both economic and behavioral theory suggest that such factors may have an important influence on its effects. There is also important variation in the content of ads, and work from other areas of health communication suggest that this content influences how consumers respond to health information, yet few analyses have assessed how qualitative and executional characteristics of DTCA may influence its effects. We propose a series of interrelated aims that capitalize on a unique combination of health care utilization data, derived from one of the largest collections of health plan insurance claims available, with measures of exposure to television ads derived from Nielson Media Research. We will supplement this information with data from the Area Resource Files and IMS Health to derive information regarding the context in which the advertising takes place. We will also develop and apply a set of codes capturing key qualitative and executional ad characteristics. The combination of these data will allow us to examine the effects of DTCA on health care utilization and pharmaceutical sales across therapeutic classes, and to explore the interaction of individual characteristics, contextual influences, and ad characteristics on the relationship between DTCA and utilization and sales. With expertise in the study of advertising and health behavior as well as pharmacoepidemiology and pharmaceutical policy, our team is highly qualified to perform the proposed research. We will use advanced econometric techniques and our analyses will yield important information for policymakers and other stakeholders seeking to optimally balance the complex risks and benefits of direct-to-consumer advertising. PUBLIC HEALTH RELEVANCE: Direct-to-consumer advertising of prescription drugs is widespread and subject to ongoing regulatory reform. We will use a novel combination of data and analytic techniques to examine how the effect of DTCA varies across therapeutic classes, and by patient, health system and ad characteristics. This information will help inform ongoing debates about the impact of DTCA and ultimately contribute to safeguarding the public health by maximizing the safe use of prescription drugs.