Personal Payments from Pharmaceutical Companies to Authors of Oncology Clinical Practice Guidelines

Abstract

Background: Oncologists who author clinical practice guidelines frequently have financial relationships with the pharmaceutical industry. It is unknown whether participation on clinical practice guideline committees is associated with differences in the amounts of industry money received.

Materials and methods: We conducted a nested case-control study from August 2013 to December 2018. We manually abstracted membership records of National Comprehensive Cancer Network (NCCN) Guidelines committees for the 20 most common cancers and linked to Open Payments. The study sample included medical oncologists selected to join an NCCN Guidelines committee ("joiners") during the study period. Joiners were matched 1:2 to medical oncologists who had no participation on NCCN committees (controls) by gender, NCCN institution, and medical school graduation year. We performed difference-in-differences (DiD) estimation to assess whether selection to an NCCN committee was associated with the dollar value of payments received from industry, using generalized estimating equations to address correlation between matched pairs and between repeated observations of the same pair.

Results: During the study period, 54 physicians joined an NCCN Guidelines committee. These physicians received more payments than matched controls in the year prior to joining ($11,259 vs. $3,427; p = .02); this difference did not increase in the year after joining (DiD = $731; p = .45).

Conclusion: Medical oncologists selected to NCCN Guidelines committees had greater financial ties to industry than their peers. The potential influence of industry in oncology clinical practice guidelines may be reduced through the selection of committee members with fewer ties to industry.

Implications for practice: Oncologists who author clinical practice guidelines frequently have financial conflicts of interest with the pharmaceutical industry. This creates concern about the potential for industry influence on guidelines. However, it is unknown whether oncologists who author guidelines have greater industry relationships than their peers. This study compared medical oncologists who were newly selected to join a National Comprehensive Cancer Network (NCCN) Guidelines panel with medical oncologists at the same institutions and at similar career stages. At the time they joined, oncologists joining NCCN Guidelines panels had received more than three times the dollar value of industry payments than their peers. The potential for industry influence may be reduced by the selection of less-conflicted panel members.

Keywords: Clinical practice guidelines; Conflict of interest; Industry payments; Open Payments; Pharmaceutical industry.

Figure 1

Time trends in industry payments among different groups of medical oncologists. Mean, annual U.S. dollar values of industry payments to oncologists in each group are shown. “All medical oncologists” includes physicians present in National Plan and Provider Enumeration System with active National Provider Identifiers who had a specialty (from Physician Compare data) of medical and oncology. Address was then used to identify the subset of all oncologists who were located at a NCCN institution (“Oncologists at NCCN institutions”). Historical versions of the NCCN Guidelines were used to manually identify the subset of these oncologists at NCCN institutions who were ever a member of an NCCN Guidelines committee during the study period (“Oncologists with any NCCN Guidelines committee participation”). Of this group, the subset that first began participation on an NCCN Guidelines committee during the study period was identified (“Oncologists beginning NCCN Guidelines committee participation”), and these physicians were matched to controls (who had no NCCN Guidelines committee participation) by gender, institution, and medical school graduation year. Abbreviation: NCCN, National Comprehensive Cancer Network.

Figure 2

Distribution of payments received by oncologists in the year before and after joining a National Comprehensive Cancer Network Guidelines committee. The percentage of joining physicians (“joiners”) and matched controls are shown for the 365 days prior to beginning participation (t = 0) and the 365 days subsequent to beginning participation (t = 1).