The rise of digital direct-to-consumer advertising?: Comparison of direct-to-consumer advertising expenditure trends from publicly available data sources and global policy implications

Tim K Mackey,Raphael E Cuomo,Bryan A Liang

doi:10.1186/s12913-015-0885-1

Abstract

BackgroundPharmaceutical marketing is undergoing a major shift in the United States, in part due to new transparency regulations under the healthcare reform act. Changes in pharmaceutical marketing practices include a possible shift from more traditional forms of direct-to-consumer advertising towards emerging use of Internet-based DTCA (“eDTCA”) given the growing importance of digital health or “eHealth.” Though legally allowed only in the U.S. and New Zealand, eDTCA poses novel regulatory challenges, as it can cross geopolitical boundaries and impact health systems and populations outside of these countries.MethodsWe wished to assess whether changes in DTCA and eDTCA expenditure trends was occurring using publicly available pharmaceutical marketing data. DTCA data was analyzed to compare trends in aggregate marketing expenditures and to assess if there were statistically significant differences in trends and magnitudes for data sources and DTCA sub-categories (including eDTCA). This was accomplished using regression lines of DTCA trend data and conducting pairwise comparisons of regression coefficients using t-tests. Means testing was utilized for comparing magnitude of DTCA expenditure.ResultsData from multiple data sources indicate that aggregate DTCA expenditures have slightly declined during the period from 2005–2009 and are consistent with results from other studies. For DTCA sub-categories, television remained the most utilized form of DTCA, though experienced trends of declining expenditures (−13.2 %) similar to other traditional media platforms such as radio (−30.7 %) and outdoor ads (−12.1 %). The only DTCA sub-category that experienced substantial increased expenditures was eDTCA (+109.0 %) and it was the only medium that had statistically significant differences in its marketing expenditure trends compared to other DTCA sub-categories.ConclusionsOur study indicates that traditional DTCA marketing may be on the decline. Conversely, the only DTCA sub-category that experienced significant increases was eDTCA. However, to fully understand this possible shift to “digital” DTCA, improvements in publicly available DTCA data sources are necessary to confirm changing trends and validate existing data. Hence, utilizing the newly implemented U.S. physician-payment expenditure transparency requirements, we advocate for the mandatory disclosure of DTCA/eDTCA in order to inform future domestic and international health policy efforts regarding appropriate regulation of pharmaceutical promotion.

Highlights

Pharmaceutical marketing is undergoing a major shift in the United States, in part due to new transparency regulations under the healthcare reform act
Our study indicates that traditional direct-to-consumer advertising (DTCA) marketing may be on the decline
Utilizing the newly implemented U.S physician-payment expenditure transparency requirements, we advocate for the mandatory disclosure of DTCA/emerging use of Internet-based DTCA (eDTCA) in order to inform future domestic and international health policy efforts regarding appropriate regulation of pharmaceutical promotion

Summary

Introduction

Pharmaceutical marketing is undergoing a major shift in the United States, in part due to new transparency regulations under the healthcare reform act. In the 1990s, expanding pharmaceutical industry marketing budgets aggressively targeted physicians through deployment of tens of thousands of pharmaceutical sales representatives and use of other promotional strategies [2, 3] During this same time period, prescription drug spending experienced a nearly sixfold increase from $40.3–$234.1 billion between 1990–2008 [4, 5]. The emergence of direct-to-consumer advertising (“DTCA”) in the late 1990s - a form of pharmaceutical marketing that directly advertises prescription drugs and targets the consumer/patient – represented a new opportunity for industry marketing diversification and influencing prescription drug sales and utilization [6,7,8]. This marketing phenomenon is unique, as it is only permitted in the U.S and New Zealand among developed countries, though forms of direct and indirect promotion to consumers (e.g., promotional materials, reminder advertisements, “infomercials,” and unbranded advertising campaigns) can occur outside these two countries [6, 9,10,11,12]

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