DISCUSSION
In this study, we found 70.0% of all Japanese PHOs increasingly
received the personal payments from pharmaceutical companies between
2016 and 2019. This study was the second study assessing board
certificated specialists in Japan, only following Ozaki et
al.8 Compared to their findings, the average payments
to PHOs was only 0.15 times lower than that to the general
hematologist-oncologists in Japan ($740 in PHO vs $4,383 in
certificated general hematologist-oncologists per
year).8 Considering that the number of pediatric
cancer patients accounts for only about 0.2% of the total number of new
cancer patients in Japan annually, it is reasonable that the average
payment to PHOs is lower than that to general hematology-oncologists.
Meanwhile, we found that the average personal payments increased twofold
in the four years. The increase in the average payment could be
attributed to the fierce marketing competition for the new drugs for
hemophilia. Specially, among the top five companies, while the total
payments from Kyowa Kirin and Sumitomo Dainippon Pharma remained
constant or decreased, the payments from Chugai, Takeda, and Bayer
continuously increased through the four years. All the three companies
had the novel drugs approved for hemophilia A during the four-years such
as Emicizumab (HEMLIBRA approved in May 2018) from Chugai
Pharmaceutical; rurioctocog alfa pegol (ADYNOVATE approved in December
2017) and rurioctocog alfa (ADVATE approved in August 2019) from Takeda
Pharmaceutical; octocog alfa (KOVALTRY approved in March 2016) and
damoctocog alfa pegol (JIVI approved in September 2018) from Bayer
Yakuhin.
As described previously, the manual collection of payments from
pharmaceutical companies may include human error and no inclusion of
payments concerning meal, accommodation, travel, and education could
lead to underreported payment value6-8, but in
conclusion, majority of Japanese pediatric hematologists and oncologists
received an increasingly large amounts of personal payments from
pharmaceutical companies with novel drugs for congenital blood disorder
for the reimbursement of lecturing, writing, and consulting between 2016
and 2019.