Abstract
Drug company payments to health care organizations can create conflicts of interest. However, little is known about such financial relationships, especially outside the United States. To examine the concentration and patterns of drug company payments to health care organizations in the United Kingdom. This cross-sectional study examined nonresearch payments reported in the industry-run Disclosure UK database. Companies participating in Disclosure UK in 2015 and health care organizations receiving their payments were included in the analysis. The data were analyzed descriptively at the health care organization, payment, and donor levels, considering health care organization categories, payment categories, and companies from February 5 through May 28, 2017, with follow-up checks from June 1 through August 31, 2018. Analysis was conducted from July 10 through December 20, 2018. Share of funding and the Gini index (GI) to measure payment concentration (0 indicates perfect deconcentration [eg, all drug companies provide the same value of payments]; 1, perfect concentration [eg, 1 company provides the entire value of payments]) and median and interquartile range (IQR) to measure payment patterns. A total of 4028 health care organizations received 19 933 payments, worth US $72 110 156.6, from 100 companies. This study identified 11 categories of health care organizations, with 3-public-sector secondary and tertiary care providers, education and research providers, and professional organizations-accumulating 67.2% of funding. The health care organization categories had varying GIs (range, 0.65-0.92), medians (range, $750.3-$45 862.4), and IQRs (range, $389.1-$1843.9 to $3104.4-$199 868.2). Of 4 payment categories, the top category-donations and grants-captured 50.6% of funding. Joint working (collaborative projects with nonindustry partners) had a lower GI (0.64) than other payment categories (range, 0.79-0.84). The median and IQR were the lowest for contributions to costs of events ($366.8; IQR, $229.3-611.3) and highest for joint working ($14 903.7; IQR, $3185.0-34,748.4). The top 10 firms (58.6% of funding) had payments with varying medians (from $366.8 [IQR, $244.5-611.3] to $9781.3 [IQR, $1834.0-48 906.7]). Although organizations from across the health care system received funding, the payments were concentrated on a few large donors, payments, and recipients. Different payment and recipient categories had different patterns of payment values, suggesting that the industry has diversified its funding strategies across different parts of the health care system. These results suggest that Disclosure UK requires improved transparency, particularly by including built-in recipient categories, and that organizational conflicts of interest need more policy attention, including disclosure of payments independent of the industry.
Highlights
Unlike in the United States,[1,2,3,4] little European research on pharmaceutical industry payment disclosures has been performed
The only exception is Disclosure UK, a freely accessible database maintained by the Association of the British Pharmaceutical Industry (ABPI), representing firms that provide the National Health Service (NHS), the United Kingdom’s single-payer health system, with more than 80% of patented drugs according to their value.[9]
In comparing the funding recipients, we focused on the function health care organizations (HCOs) had within the health care system and their sector, with specific categories emerging inductively through iterative reading of online descriptions of HCOs
Summary
Unlike in the United States,[1,2,3,4] little European research on pharmaceutical industry payment disclosures has been performed This lack is unsurprising given the pervasive nondisclosure of payments by health care professionals in many countries.[5,6] The ability to refuse to disclose received payments results from the interpretation of European privacy law by individual companies and national pharmaceutical industry trade groups managing the disclosure process in most countries.[7] These privacy provisions do not extend to health care organizations (HCOs),[8] but research is impractical because the European self-regulatory disclosure system does not require the establishment of centralized payment databases adaptable for efficient analysis.[7]. In 2015, the first year Disclosure UK operated, 52 of 53 ABPI members reported payments to HCOs, and 49 other drug companies did so voluntarily.[11,12]
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