Bulk of $220 million industry payments to rheumatologists concentrated among top 6%

Pharmaceutical industry payments to U.S. rheumatologists topped $220 million from 2014 through 2019, with 78% of that total going to just 6% of recipients, according to an analysis of CMS data published in Arthritis & Rheumatology.

The analysis also revealed a gender gap in industry payments, with men receiving more than twice as much, on average, as women, the researchers wrote.

“Conflicts of interest have been identified by rheumatologists as an important ethical concern, but the nature, geographic distribution, and quantity of payments to rheumatologists have yet to be investigated,” Michael S. Putman, MD/MSci, of the Medical College of Wisconsin, and colleagues wrote. “Such payments have been characterized in multiple other medical subspecialties using the CMS Open Payments Database. This database was established as part of the 2010 Sunshine Act, which mandated reporting of pharmaceutical industry payments to physicians.”

“A recent investigation of industry payments to authors of rheumatology clinical practice guidelines revealed that the majority had accepted payments, though most had accepted less than $10,000 in total payments and only one in five had accepted payments relevant to the clinical practice guidelines,” they added. “No studies to date have characterized the volume or geographic distribution of payments to rheumatologists.”

Michael S. Putman

To examine the nature, quantity and geographical distribution of pharmaceutical industry payments to U.S. rheumatologists, Putman and colleagues analyzed data from the CMS Open Payments database. This publicly available database includes payments from applicable manufacturers and group purchasing organizations to physicians, including fellows and part time providers. According to the researchers, internal reviews of the database have found less than 1% of records to be missing, inaccurate or inconsistent.

After downloading the payment information on Oct. 1, 2020, the researchers focused their analysis on the 6-year period from 2014 through 2019. They identified rheumatologists’ gender by linking them through the National Plan and Provider Enumeration System (NPPES) registry. They reported their data in aggregate, with trends examined using linear regression models and comparisons between genders assessed using the Wilcoxon rank-sum test.

According to the researchers, the pharmaceutical industry gave a total of $221,254,966 to 5,723 rheumatologists, across 1,610,668 payments, from 2014 through 2019. The median payment was $15 (interquartile range = $10 to $22) and the median amount of each payment received by an individual rheumatologist was $2,818 (IQR = $464 to $11,560). Although 59% received less than $5,000 in payments, 6% received more than $100,000 each, accounting for 78% of the total. The annual value of payments increased over time by $3,703,264 per year (P < 0.001).

The median payment to men was $3,732 (IQR = $542 to $15,84), “significantly higher” than the median payment to women, at $2,084 (IQR = $394 to $8,186) (P < .001), the researchers wrote.

The top three companies by total spending during this period were Bristol Myers Squibb, Abbvie and Pfizer, which together accounted for 49% of all payments. The top 10 medications accounted for 51% of the total spending during this time. The top three drugs in terms of total spending were Otezla (apremilast, Celgene), at $20,724,517; Humira (adalimumab, AbbVie), at $17,581,683; and Xeljanz (tofacitinib, Pfizer), $13,700,701.

“Collaborations between rheumatologists and the pharmaceutical industry have provided enormous value to patients with rheumatic diseases,” Putman told Healio Rheumatology. “We should be more involved in designing trials, conducting trials, and participating in trials. However, I suspect that some of these collaborations are more about marketing and influencing rheumatologists to provide low-value care. Encouraging collaborations between rheumatologists and the pharmaceutical industry that are valuable — and discouraging or placing limits on those that are not — should be a focus of the coming years.”