A new report from the Congressional Budget Office examines promotional spending by drugmakers, including an analysis of direct-to-consumer advertising in recent years. For those in the know, there are probably few surprises. Nonetheless, the summary is interesting and worth noting. Here are some highlights…

- In 2008, spending on DTC ads totaled $4.7 billion, nearly one-fourth of industry spending for all promotional activities. Promotional spending, which includes detailing, ad journals, meetings and DTC ads, was $20.5 billion last year, or 10.8 percent of US sales last year. The CBO, which says spending was typically between 10 percent and 12 percent since the early 1990’s, cited sales data reported by PhRMA, which presumably relies on annual reports. DTC advertising has declined in recent years, although detailing has grown dramatically over the past two decades.

- The growth of overall promotional spending has slowed from a double-digit annual pace in 2003 and 2004 to a rate that is close to zero. The CBO suggests the slowdown is probably related, at least in part, to the decline in the number of new drugs that have received FDA approval since 2000.

- Drugmakers ran DTC ads for less than 100 meds each year since 1995, which means DTC advertiing was the least frequently used form of drug promotion. Journal ads and professional meetings are used to promote fewer drugs than detailing but more drugs than DTC advertising. The average spent on those drugs for which DTC advertising was used amounted to $41.8 million, compared with an average of $10.4 million on detailing for the same drugs. And the 10 drugs where DTC spending was highest last year accounted for 30 percent of all DTC spending.

- As the chart shows, more is spent to on DTC ads for some types of drugs than others. Not surprisingly, impotence pills are widely promoted to consumers, while cholesterol pills are more heavily detailed to docs. After all, how many people will make a point of asking their doc for a particular statin? But we know something about the demand for erectile dysfunction elixirs.

- For drugs where DTC was used, drugmakers spent an average of $40.5 million per drug last year on promotional activities directed to docs, or 14 times the average amount spent when promoting drugs exclusively to physicians. The CBO posits the dfference may indicate drugmakers use promotional activities directed to docs and DTC ads to reinforce each other.

- Drugmakers tends to reduce spending for both DTC ads and detailing the longer the product is on the market. The longer a product remains on the market, the more likely it is to face competition both from other brand-name meds and generics. For advertised drugs, the average spending on DTC per drug stays fairly constant for several years, while average spending for detailing falls off more quickly, dropping 18 percent from the first year to the second year.