Journal of Pediatric Neurology
DOI: 10.1055/s-0042-1756444
Letter to the Editor

# Industry Payments to Pediatric Neurologists: An Analysis from the Open Payments Program

› Author Affiliations

Industry–physician financial relationships are considered as the potential conflict of interest due to possible undue influence on health care decision-making. Due to this concern, Centers of Medicaid and Medicare Open Payments Program (OPP) was established by the Physician Payments Sunshine Act of 2009. OPP mandates the reporting of industry payments made to physicians, teaching hospitals, medical product manufacturers, and group purchasing organizations. The information about eligible payments has been available through the OPP web site since August 2013. Although most physicians see these collaborations as appropriate, many links exist between industry payments and related research, medication prescribing patterns, education, and an increase in health care costs.[1] Several studies have investigated the industry payments to physicians across multiple specialties including neuromuscular neurology, neurotology, and vascular neurology.[2] [3] [4] [5] In this study, we explored the trends in the industry payments for board-certified child neurologists (CNs) in the United States.

A retrospective analysis was performed on the data extracted from the OPP database from January 1, 2014, through December 31, 2018. Data on industry payments to CNs are available under the physician specialty Allopathic & Osteopathic Physicians, Psychiatry & Neurology, and Child Neurology. We excluded the research and ownership payments and analyzed only general payments. The general payments were divided into nine subcategories: compensation for service, consultation, education, food and beverage, gift, grant, honoraria, royalty, and travel and lodging ([Fig. 1A]). Each payment carried a unique physician profile identification, recipient state, sponsor, and related product (drug, biological, or device). In the OPP database, separate entries exist for each payment for physicians who receive multiple payments. The individual payments were aggregated to obtain the total payment to each pediatric neurologist and total payment by each sponsor using sponsors' name. The American Board of Psychiatry and Neurology publishes twice yearly a publicly available online database with the total number of practicing CNs in the United States. Using the total number of CNs obtained from this database as the denominator, we calculated the proportion of them who received industry payments. Mean, median, and 90th percentile were calculated for these payments. To explore the distribution of payments among CNs, we calculated the Gini index (a statistical measure of dispersion) for those physicians who received any payment each year. The Gini index ranges from 0 (every physician received equal number of payments) to 1 (one physician received all the payments). We also analyzed geographic patterns of industry payments by U.S. census regions.

During the study period, a total of $27,604,490 was made to CNs ([Table 1]). The mean payment per year ranged from$3,885 to 6,232 and Gini index from 0.92 to 0.93. The top 10% of CNs received 89 to 91% of the total payments in the study period. “Compensation for services ($7,708,367)” and “royalty or license ($8,349,455)” were the two highest payment categories ([Fig. 1A]). Both categories showed consistent growth over the study period ranging from $607,234 in 2014 to$2,546,629 by 2018 and $1,127,260 in 2014 to$2,052,798 in 2018, respectively. CNs in the southern region of the United States received a markedly higher payments (62% of the total payments). Following the South, was the Midwest and the Northeast regions ([Table 2]). The most common drugs associated with payments to CNs in 2018 include Sabril, Fycompa, and Spinraza ([Fig. 1B]). Sabril retained the top payment per year every year. Payments ranged from $1,346,538 to 2,182,976, accounting for 34.2 to 43.4% of total payments. Table 1 ### Industry payment trends to child neurologists 2014–2018 Payment trends 2014 2015 2016 2017 2018 Number of physicians received payment 933 976 1,042 1,058 1,179 Total number of board certified physicians 2,384 2,487 2,620 2,738 2,869 Percentage of recipients 39 39 40 39 41 Total value of payment in U.S. dollars 3,624,755 4,291,549 5,332,309 6,148,107 7,347,064 Mean payment in U.S. dollars 3,885 4,397 5,117 5,811 6,232 Median payment in U.S. dollars 224 227 219 207$204

Interquartile range (IQR) in U.S. dollars

760

816

925

870

1,093

Gini index

0.92

0.93

0.93

0.93

0.93

Top 10% total payment in U.S. dollars

3,238,108

3,886,854

4,815,499

5,620,569

6,701,676

Percentage top 10% payment

89

91

90

91

91

Maximum payment in U.S. dollars

1,127,423

1,322,145

1,681,426

2,166,563

2,052,798

Table 2

### Payments to child neurologists in the different regions of the United States

Region

2014

2015

2016

2017

2018

Total

Midwest ($) 774,700 888,839 1,297,582 1,249,211 1,338,192 5,765,821 Northeast ($)

273,660

360,459

437,397

689,217

882,194

2,752,393

South ($) 2,262,030 2,681,233 3,296,648 3,906,771 4,582,164 17,114,612 West ($)

313,634

359,818

299,036

297,341

535,790

1,949,377

Puerto Rico ($) 731 1,200 1,646 5,566 8,723 18,320 Total ($)

3,624,755

4,291,549

5,332,309

6,148,107

7,347,064

27,600,524

Our findings indicated that total amount paid to CNs increased overtime; however, only a stable number of physicians received those payments. About 60% of board-certified CNs did not receive industry payments which is somewhat higher than that of other neurological specialties. It is not uncommon for industries to seek physicians who are perceived as key opinion leaders. The highest paid category was “compensation for services” that include speaking, training, and education engagements that are not for continuing education. Few newer therapies were associated with higher payments likely due to the need for awareness of such newer therapies. A noted discrepancy exists between the number of CNs receiving payments from industry with 10% of CNs in the United States receiving 90% of industry payments.

To the best of our knowledge, this is the first study that explored the relationship between industry and CNs using publicly available database. It is important to understand this collaborative relationship, as there are controversies surrounding financial relationships between industry and physicians, and the potential influence of such relationships on research and patient care. Further studies are needed to elucidate if the industry payments to CNs influence research, clinical practice, or prescribing patterns.