The physician payments Sunshine Act and medical oncology: a seven-year financial analysis

Abstract

The integration of pharmaceutical and medical device companies with clinical practice is under scrutiny due to financial incentives that may influence oncology care. The Physician Payments Sunshine Act mandates transparency in these financial relationships. This study examines the trends in non-research payments to oncology specialists between 2017 and 2023, analyzing amounts, reasons, and variations by subspecialty and region. We conducted a retrospective analysis of the Centers for Medicare and Medicaid Services Open Payments database, focusing on U.S.-based hematology, medical oncology, and hematology-oncology specialists. Payments were categorized by amount, purpose, and payment type, with temporal and geographic comparisons. Data analysis was conducted in Rstudio (version 2022.07.0) with Kruskal-Wallis, Mann-Whitney U, and Chi-square tests to assess statistical significance across specialties, regions, and payment periods. Between 2017 and 2023, 2,158,140 payments totaling $601,567,196.10 were made to 19,585 U.S.-based hematology, medical oncology, and hematology-oncology specialists. Hematology-oncology received the highest total payment amount ($393,169,915.10) and transaction count (1,700,202), while hematology had the highest median payment ($23.05) compared to hematology-oncology ($18.12) and medical oncology ($19.5). Payment patterns demonstrated seasonal peaks, particularly in Q1 and Q4, and increased markedly during major oncology conferences (ASCO, ASH). Analysis by geographic region revealed that the South consistently received the highest total payments, peaking at $36.8 million in 2023, while the Northeast had the highest median payment values, reaching $22.87 in 2023. The COVID-19 pandemic corresponded with lasting shifts in payment patterns, with median payment values rising significantly during the pandemic period and remaining elevated post-COVID across all specialties. Additionally, the distribution of payments by type revealed that direct cash payments and consulting fees were the most prominent, with hematology-oncology showing the greatest reliance on high-value cash transactions, while stock payments featured prominently in hematology. Sensitivity analyses confirmed these patterns as robust, with minimal variance observed when excluding extreme values, further validating consistent trends across specialties, regions, and periods. This study reveals specialty- and region-specific variations in oncology-related payments, with significant increases during key conferences and the COVID-19 pandemic. These findings underscore the importance of continued transparency and scrutiny in industry-oncology financial interactions to mitigate potential conflicts of interest in oncology care.

Keywords: Drug marketing; Healthcare economics; Oncology; Payment disparities; Pharmaceutical relationships; Sunshine Act; Transparency.