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Patient and provider-level factors associated with changes in utilization of treatments in response to evidence on ineffectiveness or harm

Author

Listed:
  • Laura Barrie Smith

    (University of Minnesota School of Public Health)

  • Nihar R. Desai

    (Yale School of Medicine
    Yale School of Medicine)

  • Bryan Dowd

    (University of Minnesota School of Public Health)

  • Alexander Everhart

    (University of Minnesota School of Public Health)

  • Jeph Herrin

    (Yale School of Medicine)

  • Lucas Higuera

    (Medtronic)

  • Molly Moore Jeffery

    (Mayo Clinic
    Mayo Clinic)

  • Anupam B. Jena

    (Harvard Medical School
    Massachusetts General Hospital
    National Bureau of Economic Research)

  • Joseph S. Ross

    (Yale School of Medicine
    Yale School of Medicine
    Yale School of Public Health)

  • Nilay D. Shah

    (Mayo Clinic)

  • Pinar Karaca-Mandic

    (National Bureau of Economic Research
    University of Minnesota)

Abstract

High-quality health care not only includes timely access to effective new therapies but timely abandonment of therapies when they are found to be ineffective or unsafe. Little is known about changes in use of medications after they are shown to be ineffective or unsafe. In this study, we examine changes in use of two medications: fenofibrate, which was found to be ineffective when used with statins among patients with Type 2 diabetes (ACCORD lipid trial); and dronedarone, which was found to be unsafe in patients with permanent atrial fibrillation (PALLAS trial). We examine the patient and provider characteristics associated with a decline in use of these medications. Using Medicare fee-for-service claims from 2008 to 2013, we identified two cohorts: patients with Type 2 diabetes using statins (7 million patient-quarters), and patients with permanent atrial fibrillation (83 thousand patient-quarters). We used interrupted time-series regression models to identify the patient- and provider-level characteristics associated with changes in medication use after new evidence emerged for each case. After new evidence of ineffectiveness emerged, fenofibrate use declined by 0.01 percentage points per quarter (95% CI − 0.02 to − 0.01) from a baseline of 6.9 percent of all diabetes patients receiving fenofibrate; dronedarone use declined by 0.13 percentage points per quarter (95% CI − 0.15 to − 0.10) from a baseline of 3.8 percent of permanent atrial fibrillation patients receiving dronedarone. For dronedarone, use declined more quickly among patients dually-enrolled in Medicare and Medicaid compared to Medicare-only patients (P

Suggested Citation

  • Laura Barrie Smith & Nihar R. Desai & Bryan Dowd & Alexander Everhart & Jeph Herrin & Lucas Higuera & Molly Moore Jeffery & Anupam B. Jena & Joseph S. Ross & Nilay D. Shah & Pinar Karaca-Mandic, 2020. "Patient and provider-level factors associated with changes in utilization of treatments in response to evidence on ineffectiveness or harm," International Journal of Health Economics and Management, Springer, vol. 20(3), pages 299-317, September.
  • Handle: RePEc:kap:ijhcfe:v:20:y:2020:i:3:d:10.1007_s10754-020-09282-2
    DOI: 10.1007/s10754-020-09282-2
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    References listed on IDEAS

    as
    1. David H. Howard & Guy David & Jason Hockenberry, 2017. "Selective Hearing: Physician‐Ownership and Physicians’ Response to New Evidence," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 26(1), pages 152-168, February.
    Full references (including those not matched with items on IDEAS)

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    More about this item

    Keywords

    De-adoption; Physician behavior; Disparities;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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