Author Contributions: Ms DeJong and Mr Aguilar had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The exemption of indirect payments with unidentifiable recipients (

Author Contributions: Ms DeJong and Mr Aguilar had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The exemption of indirect payments with unidentifiable recipients (

We linked data sets using physician name and location, which may have introduced inaccuracies despite exclusion of physicians with identical matching criteria. The questions that we examined should be evaluated with alternative study designs and additional years of data. The 5 months of Open Payments data may not be representative of a full year.

 

In addition to the cross-sectional design and timing of the data (5 months of payment data and 12 months of prescription data), unmeasured confounders may bias our results. The policy implications of our findings thus depend on further clarification of the mechanism of the association between the receipt of industry-sponsored meals and physician prescribing behavior. Furthermore, the relationship was dose dependent, with additional meals and costlier meals associated with greater increases in prescribing of the promoted drug.

 

We found that the receipt of industry-sponsored meals was associated with an increased rate of prescribing the brand-name medication that was being promoted. Our findings were unchanged when study group inclusion criteria were increased from 20 to 200 prescriptions in the class (eTable 6 in the Supplement ), when claims were standardized to 30-day supplies (eTable 7 in the Supplement ), and in a sensitivity analysis of only high-intensity statins, with slightly smaller effect sizes (eTable 8 in the Supplement ). Figure 2 shows predicted probabilities for prescribing the target drug, according to mean cost per meal received.

 

Quiz Ref ID Physicians receiving a single meal promoting the drug of interest were more likely to prescribe rosuvastatin over other statins (adjusted odds ratio OR, 1.18; 95% CI, 1.17-1.18), nebivolol over other β-blockers (OR, 1.70; 95% CI, 1.69-1.72), olmesartan over other ACE inhibitors and ARBs (OR, 1.52; 95% CI, 1.51-1.53), and desvenlafaxine over other SSRIs and SNRIs (OR, 2.18; 95% CI, 2.13-2.23). In multivariable logistic regression models ( Table 3 ), sponsored meals were associated with increased target-drug prescribing in each class (P <001). Characteristics of the 4 study groups are presented in Table 1 A total of 129 675 (83%) of the sample physicians were assigned to multiple study groups, and 88 724 (57%) were included in all 4 groups.

 

Next, in effect modifier analyses, we assessed whether the association between number of days receiving a meal and prescribing of a target drug was affected by mean cost per meal. To examine the relationship between cost per meal and prescribing patterns, we first restricted our regression analysis to physicians who received at least 1 meal and adjusted for the mean cost per meal received by each prescriber (<$20 or ≥$20).https://leguidedesexpertes.fr