Restrictions On Pharmaceutical Detailing Reduced Off-Label Prescribing Of Antidepressants And Antipsychotics In Children

TLDR

Pediatric depression treatment is controversial because of widespread off‑label prescribing of drugs that are not FDA‑approved and lack evidence. Academic medical centers limited pharmaceutical detailing to physicians, and a difference‑in‑differences analysis of 31 centers measured the impact of these anti‑detailing policies on prescribing patterns. The policies reduced off‑label prescriptions of promoted drugs by 11 % and on‑label prescriptions by 34 %, while increasing prescriptions of non‑promoted drugs (on‑label +14 %, off‑label +35 %), indicating that sales representatives promoted non‑approved drugs and that restricting detailing curtailed such prescribing.

Abstract

The treatment of pediatric depression is controversial because it includes substantial prescribing of drugs for uses that have not been approved by the Food and Drug Administration (“off label”) and are not evidence based. Some academic medical centers (AMCs) restrict “detailing” by pharmaceutical sales representatives, or the promoting of drugs directly to physicians via sales calls, to reduce the effect of such marketing on physician prescribing. With data from thirty-one geographically diverse AMCs and their affiliated hospitals, we used a difference-in-differences model to estimate the effect of anti-detailing policies on off-label prescribing of antidepressants and antipsychotics by pediatricians and by child and adolescent psychiatrists in the period January 2006–June 2009. We found that after the introduction of such policies, prescriptions for off-label use of promoted drugs fell by 11 percent, consistent with the ongoing presence of off-label marketing to physicians. Prescriptions for on-label use of promoted drugs fell by 34 percent after the adoption of the policies. Conversely, prescriptions for on-label use of nonpromoted drugs rose by 14 percent, and those for off-label use of nonpromoted drugs rose by 35 percent. These results suggest that pharmaceutical sales representatives promoted drugs not approved for pediatric use and that policies that restrict detailing by those representatives reduced such off-label prescribing.