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

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.

Fig. 1 (A) Total percentage spent on the nine subcategories of general payments from 2014 through 2018. (B) Top drugs responsible for payments to child neurologists in 2018 and their proportion of total payment in 2018 (x-axis). N/A, not available.

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.

Publication History

Received: 20 May 2022

Accepted: 30 June 2022

Article published online:
15 September 2022

• References

• 1 Fleischman W, Agrawal S, King M. et al. Association between payments from manufacturers of pharmaceuticals to physicians and regional prescribing: cross sectional ecological study. BMJ 2016; 354: i4189
• 2 Ahlawat A, Narayanaswami P. Financial relationships between neurologists and industry: The 2015 Open Payments database. Neurology 2018; 90 (23) 1063-1070
• 3 Harada Y, Sheng S, Thombre VA. et al. A neuromuscular-based analysis of the open payments program. Muscle Nerve 2021; 63 (01) 96-99
• 4 Nalleballe K, Sheng S, Li C. et al. Industry payment to vascular neurologists: a 6-year analysis of the open payments program from 2013 through 2018. Stroke 2020; 51 (04) 1339-1343
• 5 Ziai K, Sahyouni R, Moshtaghi O. et al. An analysis of the open payment database in neurotology. Otolaryngol Head Neck Surg 2018; 158 (02) 319-322