Does DTC Heart Drug Advertising Discourage Lifestyle Changes?

Marilynn Larkin

August 18, 2022

A 5-minute bout of direct-to-consumer advertising (DTCA) for prescription heart drugs was associated with favorable perceptions of both medication use and pharmaceutical companies, but did not seem to negate intentions to use lifestyle interventions, a survey study shows.

Participants who watched ads for various prescription heart drugs, with or without price disclosure, were more likely to report positive perceptions of drug companies and intentions to take actions such as switching medications.

The ads did not seem to affect intentions to eat healthfully and exercise.

The study was published online August 12 in JAMA Health Forum.

DTCA "Unlikely to Have an Adverse Effect"

"Increasing prevalence of DTCA may promote an over-reliance on medication over healthy lifestyle choices to manage chronic conditions," coauthor Yashaswini Singh, MPA, a PhD candidate at the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, told | Medscape Cardiology. "Thus, we hypothesized that DTCA exposure would reduce the likelihood of individuals engaging in preventive health behaviors."

"However," she said, "our results did not support this hypothesis, suggesting that exposure to DTCA for heart disease medication is unlikely to have an adverse effect on individuals' intentions to engage in diet and exercise."

That said, she added, "DTCA of prescription drugs can contribute to rising drug costs due to overprescribing of both inappropriate and brand-name drugs over cheaper generic alternatives. While we do not examine this mechanism in our paper, this remains an important question for future research."

For the study, the team recruited 2874 individuals (mean age, 53.8 years; 54% men; 83% white) from a US nationally representative sample of people at high risk of cardiovascular disease, the Ipsos Public Affairs KnowledgePanel.

Participants were randomly assigned to one of three interventions: (1) DTCA for heart disease medications; (2) DTCA for heart disease medications with price disclosure; or (3) nonpharmaceutical advertising (control). Each group watched five 1-minute videos for a total of 5 minutes of advertising exposure.

One group viewed ads for four heart disease medications — two ads for sacubitril/valsartan (Entresto, Novartis) and one each for rivaroxaban (Xarelto, Bayer), evolocumab (Repatha, Amgen), and ticagrelor (Brilinta, AstraZeneca); the second group saw the same ads, but with prices spliced in; and controls watched videos for nondrug products, such as consumer electronics.

Participants then completed a questionnaire to measure medication- and lifestyle-related intentions, as well as health-related beliefs and perceptions. Using a scale of 1 (highly unlikely) to 5 (highly likely), they rated the likelihood of their switching medication, asking a physician or insurer about a medication, searching for the drug online, or taking it as directed. The same scale was used to rate the likelihood of their being more physically active or eating more healthfully.

On a scale of 1 (always disagree) to 5 (always agree), they also related their perceptions of pharmaceutical manufacturers as being competent, innovative, and trustworthy.

To measure the magnitude of DTCA associations, the researchers calculated marginal effects (MEs) of treatment — ie, the difference in probability of an outcome between the treatment and control arms.

They found a positive association between DTCA and medication-related behavioral intentions, including intention to switch medication (ME, 0.004; P = .002) and engage in information-seeking behaviors (ME, 0.02; P = .01).

There was no evidence suggesting that pharmaceutical DTCA discouraged use of nonpharmacological lifestyle interventions to help manage heart disease. DTCA also was positively associated with consumers' favorable perceptions of pharmaceutical manufacturers (competence: ME, 0.03; P = .01; innovative: ME, 0.03; P = .008).

No differential associations were seen for price disclosures in DTCA.

Questions Remain

The authors acknowledge that the study focused on short-term behavioral intentions and that "future research should focus on the long-term effects of advertising in a real-world randomized setting."

Singh said additional questions, some of which her team is investigating, include "understanding the interaction between government policies [such as] drug pricing reforms and firms' advertising decisions; understanding whether observed changes in individuals' health beliefs translate into actual changes to information-seeking behavior and healthcare utilization; and whether the demographic, political, and social characteristics of individuals shape their behavioral responses to advertising."

Johanna Contreras, MD, an advanced heart failure and transplantation cardiologist at Mount Sinai Hospital in New York City, told | Medscape Cardiology that the findings don't surprise her. "The caveat is that this study was an online survey, so it only captured the beliefs and intentions, but not patient demand for the product and use of the product."

"I do believe DTCA can create positive intentions towards the product...and could make people more receptive to interventions," she said. However, she added, the information must be presented in a balanced way.

In addition, she noted, "price is still important. I think people take pricing into account when deciding to proceed with an intervention. If the price is 'right' or a little lower than expected, then they will likely consider the product. But if the price is significantly lower, then they may not trust that it is a good product. Generic drugs are an example. Even though they are approved and far cheaper than brand names, patients are often skeptical to take them."

The study was funded with a grant from the Blue Cross Blue Shield of Illinois Affordability Cures Consortium. Singh and her coauthors have disclosed no relevant financial relationships.

JAMA Health Forum. 2022;3:e222570. Abstract

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