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The COVID-19 pandemic has had wide-ranging effects on health care, including shifting research priorities and reducing physical interactions in clinical and research settings. Research and marketing payments from pharmaceutical and medical device companies (hereafter, industry) are major sources of funding for physicians and teaching hospitals,¹ but how the COVID-19 pandemic has affected these payments is unknown. In this serial cross-sectional study, we hypothesized that the COVID-19 pandemic would be associated with changes in industry payments in multiple ways, including restrictions on in-person events changing patterns of marketing payments, disruptions in clinical trials leading to lower research expenditures, and, given the increased use of Emergency Use Authorizations, shifts in research expenditures toward products not receiving US Food and Drug Administration approval.²

We examined trends in industry research and marketing payments from 2018 to 2021 using the Centers for Medicare & Medicaid Services Open Payments database.³ Inclusion/exclusion criteria, payment classification, and product type definitions are available in the eMethods in the Supplement.

We calculated inflation-adjusted mean monthly values of marketing and research payments, overall and stratified by recipient, payment category, and product type. We compared mean monthly payment values from January 2018 through February 2020 (prepandemic period) to March 2020 through December 2021 (pandemic period). We conducted interrupted time-series analyses comparing monthly payments in the prepandemic and pandemic periods using ordinary least squares regressions with Newey-West standard errors to account for autocorrelation (eMethods in the Supplement).⁴

Because this study used only publicly available data, it was exempt from institutional review board approval, and informed consent was waived in accordance with the Common Rule (45 CFR 搂46). Stata, version 16 (StataCorp), was used for all analyses.

During the 4-year study period, 705鈥�490 physicians and 4631 hospitals received $25.2 billion in research payments and $6.0 billion in marketing payments. Compared with the prepandemic period, mean monthly research payments increased by 5.7% in the pandemic period ($485.8 million to $513.4 million), while marketing payments declined by 38.6% ($161.9 million to $99.5 million) (Figure, A). Growth in research payments was driven by increased payments for biologics and 鈥渘ot specified鈥� product types (Table). Declines were observed among all marketing payment categories (Figure, B and Table).

Interrupted time-series analyses showed that monthly marketing payments were stable prior to the pandemic, immediately declined at the onset of the pandemic by $84.6 million (95% CI, 鈥�$99.2 million to 鈥�$69.9 million), and subsequently increased at a monthly rate of $1.9 million (95% CI, $1.3 million to $2.5 million) (Table). Research payments were stable in the prepandemic period and experienced no immediate change at the onset of the pandemic. In the pandemic period, research payments for biologics increased by $4.1 million per month (95% CI, $0.3 million to $7.8 million), while there was not a statistically significant change in payments for other product types.

The COVID-19 pandemic was associated with shifts in the focus of industry payments for research and an immediate and sustained decline in payments for marketing. Research payments were stable during the pandemic despite widespread clinical trial suspensions, which may reflect clinical trial adaptations, including virtual study visits and remote outcome measurement.⁵ Growth in biologics and 鈥渘ot specified鈥� product types likely reflect shifts in research investments toward COVID-19 therapeutics and vaccines.

Marketing payments likely declined as a result of pandemic-related social distancing and visitor restriction policies but rebounded during the pandemic despite simultaneous increases in new COVID-19 cases. Growth in marketing payments during the pandemic may have reflected changes in industry marketing strategies, such as shifting to online medical education and e-detailing.⁶

Study limitations include a reliance on industry reporting, which is not verified by the Centers for Medicare & Medicaid Services, and a lack of reporting on drug samples, payments by companies without marketed products, and payments to nonclinician researchers, medical trainees, and nonteaching hospitals. Further study is needed to understand the downstream effect of large shifts in industry research and marketing payments on innovation and clinical practice.

Accepted for Publication: August 5, 2022.

Published: September 30, 2022. doi:10.1001/jamahealthforum.2022.3342

Open Access: This is an open access article distributed under the terms of the CC-BY License. 漏 2022 Uppal N et al. JAMA Health Forum.

Corresponding Author: Timothy S. Anderson, MD, MAS, Division of General Medicine, Beth Israel Deaconess Medical Center, 1309 Beacon St, Brookline, MA 02246 (tsander1@bidmc.harvard.edu).

Author Contributions: Dr Uppal had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Uppal.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: All authors.

Administrative, technical, or material support: Anderson.

Supervision: Anderson.

Conflict of Interest Disclosures: Dr Uppal reported receiving income from Quantified Ventures and Ironwood Medical Information Technologies within the 3 years prior to publication unrelated to the submitted work. Dr Anderson reported grants from the National Institute on Aging, the American College of Cardiology, the American Heart Association, and the Boston Claude D. Pepper Older Americans Independence Center outside the submitted work.