title: 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.
abstract: BACKGROUND
  Pharmaceutical 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Data 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.
  
  
  CONCLUSIONS
  Our 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.
authors.affiliation: Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, CA, USA. tmackey@ucsd.edu.|Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA. tmackey@ucsd.edu.|Global Health Policy Institute, University of California, San Diego, CA, USA. tmackey@ucsd.edu.
authors.forename: Tim K
authors.initials: TK
authors.lastname: Mackey
authors.affiliation: Global Health Policy Institute, University of California, San Diego, CA, USA. raphael.e.cuomo@gmail.com.|Joint Doctoral Program in Global Public Health, University of California, San Diego - San Diego State University, San Diego, CA, USA. raphael.e.cuomo@gmail.com.
authors.forename: Raphael E
authors.initials: RE
authors.lastname: Cuomo
authors.affiliation: Global Health Policy Institute, University of California, San Diego, CA, USA. brliang@ucsd.edu.
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Liang
mesh_terms: D000067088:Direct-to-Consumer Advertising / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends*; D005544:Forecasting; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D040541:Marketing / Q000191:economics* / Q000379:methods / Q000639:trends*; D008402:Mass Media / Q000706:statistics & numerical data; D009520:New Zealand; D011845:Radio / Q000706:statistics & numerical data; D013690:Television / Q000706:statistics & numerical data; D014481:United States