Industry funding of patient and health consumer groups: systematic review with meta-analysis

Article type
Authors
Fabbri A1, Parker L1, Colombo C2, Mosconi P2, Barbara G3, Frattaruolo MP3, Lau E1, Kroeger CM1, Lunny C4, Salzwedel DM4, Mintzes B1
1Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney
2Mario Negri Institute for Pharmacological Research IRCCS
3Gynaecology Unit, IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan
4Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver
Abstract
Background: Patient and health consumer groups often rely on the financial support of the pharmaceutical and medical device industries. Considering their important role in health policy, concerns have been raised because of conflicts of interest and potential limitations to their independence.

Objectives:To synthesise studies on prevalence of industry funding, transparency, and positions of patient and health consumer groups.

Methods: We searched Medline, Embase, Web of Science, Scopus and Google Scholar (from inception to January 2018). We included observational studies reporting at least one of the outcomes: prevalence: percent of groups that accept industry funding, percent of groups’ funding from industry, and number of funders per group; transparency: proportion of industry funded groups reporting the source of funding; positions: association between industry funding and organisational positions on health and policy issues. We carried out duplicate independent data extraction and assessed study quality using an amended version of the Checklist for Prevalence Studies developed by the Joanna Briggs Institute. For meta-analyses of prevalence, a DerSimonian-Laird estimate of single proportions with Freeman-Tukey arcsine transformation was used. We used GRADE to assess the quality of the evidence per outcome.

Results: Twenty-six cross-sectional studies were included. Most were conducted in the United States and Europe.
We meta-analysed prevalence of industry funding, proportion of industry funded groups that disclosed funding, and prevalence of group policies on sponsorship. We cannot present summary estimates for industry funding prevalence and organisational policies because of the high level of unexplained heterogeneity.
Seventeen (65%) studies were of high quality and 9 (35%) of low quality.
The prevalence of industry funding ranged from 20% (12/61) to 83% (86/104) (15 studies). Among groups having received industry funding, 27% (95% CI: 24 to 31%) disclosed the information on their website. In submissions to governmental consultations, disclosure varied from 0% to 91% (two studies). From 2% to 64% of groups had policies on sponsorship. Industry funded groups tend to hold positions in line with sponsors’ interests (four studies).

Conclusions: Patient groups often receive pharmaceutical and medical device industry funding; few disclose them on their websites. Shifts in disclosure may have occurred, as the relevant studies were published between 2008 and 2012. There was also little research in middle- or low-income countries. Few groups had formal sponsorship policies. Our findings of prevalent funding but limited governance raise concerns about risks of commercial biases in the representation of patients’ interests. To limit these risks, mechanisms for increased public financing could be explored.

Patient or healthcare consumer involvement: Two authors have been involved for years with women’s health and consumer groups. One representative of a Canadian patient group was involved in commenting the findings.