Effects of direct-to-consumer advertising and clinical guidelines on appropriate use of human papillomavirus DNA tests

Abstract

Background: Both clinical guidelines and direct-to-consumer (DTC) advertising influence the use of new health care technologies, but little is known about their relative effects. The introduction of a cervical cancer screening test in 2000 offered a unique opportunity to assess the 2 strategies.

Objective: To evaluate the effects of clinical guidelines and a targeted DTC advertising campaign on overall and appropriate use of human papillomavirus (HPV) DNA tests.

Research design: Quasi-experimental study using difference-in-differences analysis. Data were MarketScan private insurance claims for 500,000 women aged 21 to 64 enrolled at least 12 consecutive months from January 2001 through December 2005.

Results: Both clinical guidelines and DTC advertising were associated with increases in overall HPV DNA test use. DTC advertising was associated with a statistically significant increase in HPV DNA test use in 2 groups of DTC cities (+5.57%, P < 0.0001; +2.54%, P < 0.0001). DTC advertising was associated with comparable increases in the probability of appropriate and inappropriate use of the HPV DNA test in primary screening. Clinical guideline releases from the American College of Obstetricians and Gynecologists, and by a cosponsored panel, were associated with greater increases in HPV DNA tests for appropriate primary screening than for inappropriate primary screening (β = 0.3347, P < 0.05 and β = 0.4175, P < 0.01).

Conclusions: DTC advertising was associated with increased overall use of a cervical cancer screening test, whereas clinical guidelines were differentially associated with increased appropriate use. These findings suggest distinct influences of consumer marketing and professional guidelines on the use of health care products and services.

Figure 1

Timeline of FDA approvals, clinical guideline releases and direct-to-consumer advertising launches for HPV DNA tests.

Figure 2

Actual HPV DNA test use, as a proportion of all cervical cancer screening tests, in DTC and comparison cities in the pre-DTC period, January 2001 through February 2005.

Figure 3

Predicted probability of HPV DNA test use given any cervical screening test in DTC and comparison cities, January 2001 – December 2005, controlling for time trend, dates of clinical guideline releases and DTC advertising launches, age, diagnosis of atypical squamous cells of uncertain significance, urban residence, region of residence, insurance plan type, provider specialty, and months of enrollment.