Results
Of the 15,048 eligible cardiologists board-certified by the JCS, 9,858
(65.5%) received at least one personal payment from pharmaceutical
companies between 2016 and 2019 (Table 1). The total amount of these
payments was $112,934,503, entailing 164,978 payment transactions. For
cardiologists who received at least one payment, the median amount per
cardiologist was $2,947 (interquartile range [IQR]:
$1,022–$8,787), with a mean of $11,456 (standard deviation [SD]:
$35,876) over the four-year period. The Gini index was 0.840 for
personal payments per cardiologist, indicating that only a small
proportion of cardiologists received the vast majority of these
payments. Specifically, the top 1% (150 cardiologists), 5% (752
cardiologists), and 10% (1505 cardiologists) received 31.6%, 59.4%,
and 73.5% of all personal payments, respectively. Only 0.5% (67
cardiologists) received more than $200,000 payments and one
cardiologist received 565 payments totaling $782,015 over the four
years.
Lecturing payments accounted for 88.6% of the total payments
($100,067,695) in monetary value and 89.7% in the number of payments
over the four years, with 64.5% (9,710) of cardiologists receiving at
least one lecturing payment. Consulting and writing payments accounted
for 8.0% ($9.1 million) and 3.3% ($3.8 million) in monetary value.
The mean values per payment were $1,243 for lecturing, $1,236 for
consulting, and $915 for drafting services.
Of 83 pharmaceutical companies making payments to the cardiologists,
Daichi Sankyo made the largest amounts of personal payments totaling
$26.4 million (23.4% of all payments), followed by Bayer ($11.8
million; 10.4% of all payments), Boehringer Ingelheim Japan ($8.8
million; 7.8% of all payments), Otsuka Pharmaceutical ($8.3 million;
7.5% of all payments), Bristol Myers Squibb ($5.7 million; 5.0% of
all payments), and Takeda Pharmaceutical ($5.2 million; 4.6%% of all
payments). The top 5 and 10 companies with the largest payment amounts
were responsible for 54.2% ($61.2 million) and 71.3% ($80.5 million)
of all payments over the four years.
The total annual payments to cardiologists were from $27.4 million in
2016 to $28.8 million in 2017 (Table 2). Of all cardiologists, 46.4%
to 47.4% of cardiologists received at least one personal payment each
year. Median annual payments slightly increased from $1,226 (IQR:
$511–$3,247) in 2016 to $1,354 (IQR: $613–$3,335) in 2019. The
GEE models showed that there were no significant trends in the number of
cardiologists receiving personal payments (relative annual average
percentage change [RAAPC]: 0.3% [95% confidence interval: -0.2%
to 0.8%], p=0.23) and payments per cardiologist (RAAPC: 0.6% [95%
confidence interval: -0.7% to 1.8%], p=0.39) between 2016 and 2019.