title: Effect of Direct-to-Consumer Advertising on Asthma Medication Sales and Healthcare Use.
abstract: BACKGROUND
  The United States is one of only two countries that permit direct-to-consumer advertising (DTCA) of prescription drugs, and many questions remain regarding its effects.
  
  
  OBJECTIVE
  To quantify the association between asthma-related DTCA, pharmacy sales, and healthcare use.
  
  
  METHODS
  This was an ecological study from 2005 through 2009 using linked data from Nielsen (DTCA television ratings), the IMS Health National Prescription Audit (pharmacy sales), and the MarketScan Commercial Claims data (healthcare use) for 75 designated market areas in the United States. We used multilevel Poisson regression to model the relationship between DTCA and rates of prescriptions and use within and across designated market areas. Main outcome measures include (1) volume of total, new, and refilled prescriptions for advertised products based on pharmacy sales; (2) prescription claims for asthma medications; and asthma-related (3) emergency department use, (4) hospitalizations, and (5) outpatient encounters among the commercially insured.
  
  
  RESULTS
  Four Food and Drug Administration-approved asthma medicines were advertised during the period examined: (1) fluticasone/salmeterol (Advair), (2) mometasone furoate (Asmanex), (3) montelukast (Singulair), and (4) budesonide/formoterol (Symbicort). After adjustment, each additional televised advertisement was associated with 2% (incident rate ratio, 1.02; 95% confidence interval, 1.01-1.03) higher pharmacy sales rate from 2005 through 2009, although this effect varied across the three consistently advertised therapies examined. Among the commercially insured, DTCA was positively and significantly associated with emergency room visits related to asthma (incident rate ratio, 1.02; 95% confidence interval, 1.01-1.04), but there was no relationship with hospitalizations or outpatient encounters.
  
  
  CONCLUSIONS
  Among this population, DTCA was associated with higher prescription sales and asthma-related emergency department use.
authors: 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.|2 Center for Drug Safety and Effectiveness.
authors: Matthew
authors: M
authors: Daubresse
authors: 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.|2 Center for Drug Safety and Effectiveness.|3 Division of Gastroenterology and Hepatology, Department of Medicine, and.
authors: Susan
authors: S
authors: Hutfless
authors: 4 Institute for Health Research and Policy.
authors: Yoonsang
authors: Y
authors: Kim
authors: 4 Institute for Health Research and Policy.
authors: Rachel
authors: R
authors: Kornfield
authors: 5 Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, and.|6 Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, Illinois; and.
authors: Dima M
authors: DM
authors: Qato
authors: 4 Institute for Health Research and Policy.
authors: Jidong
authors: J
authors: Huang
authors: 7 Truven Health Analytics, Santa Barbara, California.
authors: Kay
authors: K
authors: Miller
authors: 4 Institute for Health Research and Policy.
authors: Sherry L
authors: SL
authors: Emery
authors: 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.|2 Center for Drug Safety and Effectiveness.|8 Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors: G Caleb
authors: GC
authors: Alexander
mesh_terms: D000329:Advertising; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D018927:Anti-Asthmatic Agents / Q000191:economics* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D004363:Drug Utilization / Q000191:economics* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016012:Poisson Distribution; D012044:Regression Analysis; D013690:Television; D014481:United States
chemical_list: D018927:Anti-Asthmatic Agents
keywords: asthma; direct-to-consumer advertising; healthcare use