Funding
There was no funding source for this study.
To the Editor: In the global movement to enhance transparency
in financial relationships between physicians and healthcare industries,
almost all payments from pharmaceutical and medical device companies to
physicians in the United States has been publicly disclosed in the Open
Payments Database since 2013.1 Allergists and clinical
immunologists are experts receiving one of the largest general payments
in the country in 2015.2 The COVID-19 pandemic might
have limited an financial interaction between pharmaceutical companies
and these experts, but few study investigated the trend in industry
payments relating to allergology and immunology during the COVID-19
pandemic.
This cross-sectional study examined the trend in financial relationships
between the industry and allergists and clinical immunologists in the
United States during the COVID-19 pandemic, using the relevant data
extracted from the Open Payments Database. All general payments made to
the physicians whose specialty was categorized as allergology or
clinical immunology between 2014 and 2020 were used. Trends in payments
before and during the COVID-19 was evaluated by the interrupted time
series (ITS) analysis using population-averaged generalized estimating
equation (GEE) models with panel-data of monthly payments at the
physician level. As the payments were highly skewed, negative binomial
regression GEE model for the payments per physician and linear
log-linked regression GEE model with Poisson distribution for the number
of physicians with payments were employed.3 As the
national emergency concerning the COVID-19 pandemic was declared in the
United States on March 13, 2020, we divided the study period into before
(January 2014 to February 2020) and during the pandemic (March to
December 2020). To adjust seasonality of the payments, we included the
month variable in the ITS models. Furthermore, descriptive analysis was
conducted for annual and aggregate payments. Average relative annual
changes in payments were also estimated by the GEE models with
panel-data of annual payments per physician.3 As this
study only included publicly available information, informed consent was
waived by the Ethics Committee of the Medical Governance Research
Institute.
There were 6046 allergists and clinical immunologists receiving 754,338
general payments with a total of $115,593,275 from 632 companies
between 2014 and 2020. The monthly payments and number of physicians
receiving payments decreased by -53.6% (95% confidence interval
[95% CI]: -59.5% – -46.9%, p<0.001) and -38.5%
(-40.1%– -36.9%, p<0.001) at the beginning of the pandemic.
(Figure 1) Although the number of physicians receiving payments
increased during the pandemic with average monthly change rate of 3.5%
(95% CI: 3.2% – 3.9%, p<0.001), there was no clinically
meaningful change in the payments per physician within the pandemic.
For annual payments, about eighty percentage of all allergists and
clinical immunologists received the payments in each year. The payments
per physician increased from $315 (interquartile range [IQR]: $95
– $1,051) in 2014 to $457 (IQR: $125 – $1,305) in 2019, with the
average relative annual change rate of 8.3% (95% CI: 5.3% – 11.4%,
p<0.001). (Table 1) However, the payments per physician
decreased by -50.8% (95% CI: -56.4% – -44.4%, p<0.001) to
$336 (IQR: $82 – $1,160) in 2020 compared with 2014 to 2019.
Despite several limitations including no inclusion of physicians without
payments and unmeasured confounding factors as in other
studies,4,5 this study is the first to demonstrate
that the COVID-19 pandemic potentially led to the decreased financial
relationships between the allergists and clinical immunologists and the
industries in the United States, by approximately half in payments per
physician. An increase of the allergists and clinical immunologists
receiving the payment since the inception of pandemic may have suggested
a gradual resumption of promotional activities by the pharmaceutical
companies in this field, but the information is lacking on whether these
activities would recover to the level before the pandemic in the long
term. Future studies should investigate a long-term trend of the
pharmaceutical payments to clarify how the promotional activities would
bias the patients’ care in this field in the foreseeable future.