Industry Payments for Vibegron and Prescribing Patterns Among Urologic Clinicians

This cross-sectional study compares the prescribing practices among urologists and advanced practice clinicians who received vs did not receive payment from drug manufacturers.


Introduction
Urologists who receive pharmaceutical industry payments often prescribe more expensive marketed medications. 1 However, the association between payments and prescribing among advanced practice clinicians (APCs) in urology is unknown, despite APCs receiving $119 million from the industry in 2021. 2,3Vibegron is the newest, highest-cost overactive bladder (OAB) medication approved by the US Food and Drug Administration. 4,5We measured the association between industry payments and prescribing patterns for vibegron by urologists and APCs during its first year on the market.

Methods
We performed a cross-sectional study of urologists and APCs (physician assistants and nurse practitioners) in single-specialty urology practices, defined as those in which most physicians were
Clinicians who received payments were often male, were younger, worked in larger practices, treated

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Open Access.This is an open access article distributed under the terms of the CC-BY License.more non-Hispanic White patients, and prescribed more vibegron than those who received no payments.
In adjusted analyses, clinicians who received any payment for vibegron were more likely to prescribe the medication than those who received no payment (odds ratio [OR], 3.61; 95% CI, 2.89-4.51;P < .001)(Table 2).Receipt of any payment was associated with an increase of 0.93% (95% CI, 0.74%-1.13%) in vibegron prescriptions as a percentage of total OAB prescriptions.Vibegron prescriptions as a percentage of total OAB claims was 1.30% (95% CI, 1.18%-1.46%)for those receiving payments vs 0.42% (95% CI, 0.33%-0.52%)for those receiving no payments.Receipt of any payment was associated with an increase of 0.77% (95% CI, 0.62%-0.93%;P < .001) in days' supply of vibegron prescriptions as a percentage of total days supply of OAB medications.The association of payments with prescribing did not differ by clinician type, although APCs were less likely to prescribe vibegron (OR, 0.37; 95% CI, 0.23-0.59;P < .001).

Discussion
Urologists and APCs who received industry payments for vibegron were more likely to prescribe it and prescribed it more often than those who did not receive payments.While this study cannot prove causality, it adds APC data to the literature and suggests that payments affect prescribing behavior similarly for both physicians and APCs.Generalizability of this study may be limited as it included only clinicians from single-specialty practices and only prescriptions for Medicare beneficiaries, although OAB prescription is most common in people older than 65 years. 6netheless, these findings are novel for APC prescribers and consistent with existing data for physicians.Clinicians should be educated on the potential implications of financial relationships with the pharmaceutical industry.Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Data Sharing Statement: See Supplement 2.
urologists according to the 2020 Medicare Data on Provider Practice and Specialty file.Clinicians who prescribed at least 11 claims of any OAB medication in the 2021 Medicare Part D Public Use File were included (eTable in Supplement 1).We used Open Payments data to calculate the value and number of payments for vibegron in 2021.The University of Chicago Institutional Review Board deemed this study exempt from ethics review and informed consent requirement because publicly available data were used.We followed the STROBE reporting guideline.Primary outcomes were a clinician prescribing vibegron, percentage of a clinician's OAB prescriptions for vibegron, and percentage of a clinician's OAB medication days' supply for vibegron.Descriptive statistics were performed with χ 2 tests; 2-sample, 2-sided t tests; and Mann-Whitney tests.Multivariable logistic and linear regressions tested the association between industry payment and prescribing.Covariates included clinician type, sex, age, and practice size and patient demographics (age, risk score, race and ethnicity [collected to account for differences in patient populations that might alter payments or prescribing], and low-income subsidy).Interaction term was included to determine whether the association between payment and prescribing differed by clinician type.P < .05indicated statistical significance.Data analysis was performed with SAS 9.4 (SAS Institute Inc) and Stata 17 (StataCorp LLC).

Table 1 .
Characteristics of Clinicians Who Received or Did Not Receive Industry Payments for Vibegron in 2021 Abbreviations: APC, advanced practice clinician; HCC, hierarchical condition category; OAB, overactive bladder; OR, odds ratio.