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Comparative Effectiveness Research, COURAGE, and Technological Abandonment

  • David H. Howard
  • Yu-Chu Shen
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    When a major study finds that a widely used medical treatment is no better than a less expensive alternative, do physicians stop using it? Policymakers hope that comparative effectiveness research will identify less expensive substitutes for widely-used treatments, but physicians may be reluctant to abandon profitable therapies. We examine the impact of the COURAGE trial, which found that medical therapy is as effective as percutaneous coronary intervention (PCI) for patients with stable angina, on practice patterns. Using hospital discharge data from US community, Veterans Administration, and English hospitals, we detect a moderate decline in PCI volume post-COURAGE. However, many patients with stable angina continue to receive PCI. We do not find differences in PCI volume trends by reimbursement scheme or hospitals' teaching status, ownership, or degree of vertical integration.

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    File URL: http://www.nber.org/papers/w17371.pdf
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    Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 17371.

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    Date of creation: Aug 2011
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    Publication status: published as Howard, D. and Shen, Y. 2012. Comparative Effectiveness Research, Technological Abandonment, and Health Care Spending. Advances in Health Economics and Health Services Research, Volume 23: 103-121.
    Handle: RePEc:nbr:nberwo:17371
    Note: HC
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