Relationship between industry payments to physicians and prescription patterns for PCSK9is, ARNis and DOACs: A report from the NCDR PINNACLE registry.

BACKGROUND

We examined the association of industry payments to physicians and prescriptions for proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, angiotensin receptor-neprilysin inhibitor (ARNi), and direct oral anticoagulants (DOAC).

METHODS

Using 2017 data from the NCDR PINNACLE Registry, we idenitifed 3 patient cohorts: those with atherosclerotic cardiovascular disease (ASCVD) and/or dyslipidemia, heart failure with reduced ejection fraction (HFrEF), and nonvalvular atrial fibrillation (NVAF). We linked physicians to the 2017 Open Payments data using National Provider Identifiers to determine whether they had received industry payments related to PCSK9 inhibitors, ARNi, or DOACs. The primary outcome of the study was the proportion of patients within each cohort who were prescribed the corresponding medication. Within each cohort, we evaluated the association between the receipt of industry payments by the treating physician (<$100, $100-$1,000, >$1,000) and likelihood of prescribing the corresponding medication using regression analyses.

RESULTS

Overall, 0.2% of ASCVD patients were prescribed PCSK9 inhibitors, 9.0% of HFrEF patients were prescribed ARNi, and 38.7% of NVAF patients were prescribed DOACs. Patients whose physicians receiveds payments related to PCSK inhibitors were more likely to be prescribed them (ASCVD cohort: odds ratio [OR] 1.35; 95% confidence interval [CI],1.15-1.57), as were patients in the HFrEF cohort prescribed ARNi (OR 1.43; 95% CI, 1.19-1.71). No significant association was observed for DOAC prescribing (OR 0.99; 95% CI, 0.95-1.03). Across all 3 cohorts, physicians who received higher-value payments were more likely to prescribe the corresponding medications than those who received lower-value payments.

CONCLUSIONS

Patients with ASCVD or HFrEF whose physicians received industry payments were more likely to be prescribed PCSK9 inhibitors or ARNi, regardless of the payment amount. For DOACs, an association with prescribing was observed only among physicians who received higher-value payments.