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Leela Barham is a freelance health economist and policy expert. She has published in peer-reviewed journals and presented at national and international conferences. She has provided advice to the Department of Health and Social Care on policy on pricing of branded medicines to inform the negotiation of a successor to the UK’s Pharmaceutical Price Regulation Scheme (PPRS), the Voluntary Scheme for Branded Medicines Pricing and Access (VPAS), as well as worked with patient groups, the NHS, pharmaceutical companies and many others internationally on the economics of healthcare and pharmaceuticals. Contact Leela on firstname.lastname@example.org
The long planned for transparency of industry payments to doctors, pharmacists, nurses and others has shone some dappled light on the UK industry, writes Leela Barham.
The long planned for transparency of industry payments to doctors, pharmacists, nurses and others has brought some dappled sunlight to the UK. As part of European wide efforts to increase transparency, the Association of the British Pharmaceutical Industry Association (ABPI) has made available Disclosure UK. The publicly available database sets out payments made by companies during the calendar year 2015 to doctors, nurses and others with a role in prescribing. But with some limitations on the database and its contents, there is still more to be done to bring bright sunshine.
Those who want to take a look at the database have two options: to interrogate the database via its online portal or to download the database content in an excel spreadsheet. The online portal might well be what patients will use; they can look up their GP or specialist and find out how much they’ve been paid, for what (in high level categories covering registration fees, travel and accommodation, consultantcy fees and related expenses, sponsorship and/or donations and grants) and by which companies.
For those who want to get a sense of industry behaviour the three page spreadsheet covers conditions of use, a sheet called ABPI UK Disclosure which lists named recipients as well as organisations and an aggregate sheet which provides the full amounts paid by companies for both individuals who have opted not to have their named shared as well as research and development related payments. Whilst an excel spreadsheet means it will pretty much be in a format anyone can open, don’t expect this to be an easy to navigate database with some pre-specified basic analysis. However if you’re prepared to put the time in, it can provide some useful insights.
The big spenders are probably those companies you’d expect; Astra Zeneca tops the list with £42 million in total (12% of the total £363 million spent for the 109 companies in the database*). The top ten are:
Share of grand total
Roche Products Limited
Novartis Pharmaceuticals UK Ltd
Merck Sharp & Dohme Ltd
Bristol-Myers Squibb Pharmaceuticals Ltd
Servier Laboratories Ltd
Together they account for £237 million, or 65% of the grand total.
Just to illustrate the effort required to work this out; analysis of over 50,000 rows of data.
Type of spend
Payments related to research and development were always going to be presented as aggregate spend by companies as industry has argued that these details are already available in the public domain. R&D payments are the biggest category of spend, some £253 million and dominate aggregate payments (payments to individuals who did not wish to be named) (figure 1). R&D accounts for 70% of the grand total (aggregate payments and payments attributed to named individuals and organizations).
It’s proven a task too far to identify just which person (of those who agreed for their name to be published) has received the most. That’s because it seems to require manual aggregation; the database doesn’t provide a unique reference number for a person and with the potential for the same name to be different professionals, as well as professionals potentially moving between employers, and more than one company paying them, it’s not easy to design a look up to help (or my excel skills have failed me). Eyeballing over 50,000 entries would take some time.
Easier, but incomplete, is identifying the biggest payments. On that basis, the biggest payment to an individual was £87,954.56 from Allergan Ltd to Dr Raj Acquilla as a fee for service.
UCB Pharma Ltd paid the most in a single donation of £1.1 million to King’s College London. In fact, named organisations received £56 million; that puts the £24 million named individuals payments in the shade. It also reveals that the industry makes a not insignificant contribution to a number of organistions, including NHS organisations. As an example, Addenbrookes received just shy of £400,000.
Full company disclosure: partial information from professionals
Individuals have the right to opt out of their names being revealed in company submissions to the database. That is a source of concern to some; after all if there’s nothing to hide, then why hide your name?
GSK has already put a policy in place that it will only want to work with those who are willing to have their names published. NHS England is calling on other companies to follow suit.
More sunlight needed
There will be many who will be pleased to see the UK industry take a further step in opening up on what remains a contentious area. However, there will be those who might like those receiving the payments being more willing to have their name in the public domain.
There is also a broader interest in payments; with concern about how attractive the UK now is in light of potentially leaving the EU, the database could serve as an additional benchmark. If companies place a greater priority on engaging with individuals and organizations outside of the UK, the database could signal that through declining payments. Will it be £363 million this time next year, or less?
* The database is dynamic, so the total based on the spreadsheet downloaded on 1 July was more than the ABPI press release figure of £340 million.
Leela Barham is an independent health economist and policy expert. You access her website here and contact her at email@example.com