Increasing Financial Payments From Industry to Medical Oncologists in the United States, 2014-2017

Abstract

Background: Personal payments from the pharmaceutical industry to US physicians are common and are associated with changes in physicians' clinical practice and interpretation of clinical trial results. We assessed temporal trends in industry payments to oncologists, with particular emphasis on payments to authors of oncology clinical practice guideline and on payments related to immunotherapy drugs.

Methods: We included US physicians with active National Plan and Provider Enumeration System records and demographic data available in the Centers for Medicare & Medicaid Services Physician Compare system who had a specialty type of medical oncology or general internal medicine. Medical oncologists serving on NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Panels were identified manually. Industry payments, and the subset associated with PD-1/PD-L1 drugs, were identified in Open Payments, the federal repository of all transactions of financial value from industry to physicians and teaching hospitals, from 2014 to 2017.

Results: There were 13,087 medical oncologists and 85,640 internists who received payments. The mean, annual, per-physician value of payments to oncologists increased from $3,811 in 2014 to $5,854 in 2017, and from $444 to $450 for internists; the median payment increased from $152 to $199 for oncologists and remained at $0 for internists. Oncologists who served on NCCN Guidelines Panels received a greater value in payments and experienced a greater relative increase: mean payments increased from $10,820 in 2014 to $18,977 in 2017, and median payments increased from $500 to $1,366. Among companies marketing PD-1/PD-L1 drugs, mean annual per-oncologist payments associated with PD-1/PD-L1 drugs increased from $28 to $773. Total per-oncologist payments from companies marketing PD-1/PD-L1 drugs experienced a 165% increase from 2014 to 2017, compared with a 31% increase among similar companies not marketing PD-1/PD-L1 drugs.

Conclusions: Pharmaceutical industry payments increased for US oncologists from 2014 to 2017 more than for general internists. The increase was greater among oncologists contributing to clinical practice guidelines and among pharmaceutical companies marketing PD-1/PD-L1 drugs. The increasing flow of money from industry to US oncologists supports ongoing concern regarding commercial interests in guideline development and clinical decision-making.

Keywords: clinical practice guidelines; conflicts of interest; industry payments; medical ethics; open payments.

Figure 1.

Annual per-physician (A) mean, (B) median, and (C) median dollar value of industry payments to physicians in each category within each calendar year. ^aPhysicians who had a subspecialty related to medical oncology, including those who served as a panelist on an NCCN Guidelines committee (n=13,087). ^bPhysicians who had a specialty type of internal medicine and no other subspecialty (n=85,640). ^cThe subset of oncologists who served as a panelist on 1 (or more) of the NCCN Guidelines committees for the 30 most prevalent cancer types in the United States during the 2014–2017 study period (n=308).

Figure 2.

Mean annual per-physician dollar value of general payments to oncologists from pharmaceutical companies that manufactured a PD-1/PD-L1 agent (solid line) and the subset of those payments from that company associated with its PD-1/PD-L1 drug (dashed line). In cases where a single PD-1/PD-L1 drug was comarketed by >1 pharmaceutical company, total payments across both companies are included. The initial FDA approval for each drug occurred in the following years: pembrolizumab, 2014; nivolumab, 2014; atezolizumab, 2016; avelumab, 2017; durvalumab, 2017.

Figure 3.

Mean annual per-physician dollar value of general industry payments to oncologists over career trajectory, grouped by medical school graduation year(1970–2014). Individual cohorts of physicians were created based on shared graduation year, and payments over the 2014–2017 study period are shown for each cohort. The 27 oncologists who graduated from medical school after 2014 are not shown.