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Author Notes:

Address correspondence to David H. Howard, Ph.D., Department of Health Policy and Management, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322; e-mail: david.howard@emory.edu. Carolyn Kenline, M.S., is with the Department of Health Policy and Management, Emory University, Atlanta, GA. Hillard M. Lazarus, M.D., is with the University Hospitals Case Medical Center, Case Comprehensive Cancer, Cleveland, OH. Charles F. LeMaistre, M.D., is with the Texas Institute of Medicine and Surgery, San Antonio, TX. Richard T. Maziarz, M.D., is with the Adult Blood and Marrow Stem Cell Transplant Program, Oregon Health and Science University, Portland, OR. Philip L. McCarthy Jr., M.D., is with the Blood and Marrow Transplant Program, Roswell Park Cancer Institute, Buffalo, NY. Susan K. Parsons, M.D., M.R.P., is with The Health Institute, ICRHPS, Tufts Medical Center, Boston, MA. David Szwajcer is with the Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. J. Douglas Rizzo, M.D., M.S., is with the CIBMTR, Froedtert and the Medical College of Wisconsin Clinical Cancer Center, Milwaukee, WI. Navneet S. Majhail, M.D., M.S., is with the Masonic Cancer Center, University of Minnesota, Minneapolis, MN.

Subject:

Research Funding:

The principal investigator acknowledges the support of American Cancer Society Mentored Research Scholar Grant 110989-MRSG-06-075-01-CPHPS. The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA76518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI), and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U01HL069294 from NHLBI and NCI; a contract HHSH234200637015C with Health Resources and Services Administration (HRSA/DHHS); two grants N00014-06-1-0704 and N00014-08-1-0058 from the Office of Naval Research; and grants from AABB; Allos Inc.; Amgen Inc.; Anonymous donation to the Medical College of Wisconsin; Astellas Pharma US Inc.; Be the Match Foundation; Biogen IDEC; BioMarin Pharmaceutical Inc.; Biovitrum AB; BloodCenter of Wisconsin; Blue Cross and Blue Shield Association; Bone Marrow Foundation; Buchanan Family Foundation; CaridianBCT; Celgene Corporation; CellGenix, GmbH; Children's Leukemia Research Association; ClinImmune Labs; CTI Clinical Trial and Consulting Services; Eisai Inc.; Genentech Inc.; Genzyme Corporation; Histogenetics Inc.; HKS Medical Information Systems; Hospira Inc.; Kirin Brewery Co. Ltd.; The Leukemia & Lymphoma Society; Merck & Company; The Medical College of Wisconsin; Millennium Pharmaceuticals Inc.; Miller Pharmacal Group; Milliman USA Inc.; Miltenyi Biotec Inc.; National Marrow Donor Program; Nature Publishing Group; Novartis Oncology; Oncology Nursing Society; Osiris Therapeutics Inc.; Otsuka America Pharmaceutical Inc.; Pall Life Sciences; Pfizer Inc; Schering Corporation; Sigma-Tau Pharmaceuticals; Soligenix Inc.; StemCyte Inc.; StemSoft Software Inc.; Sysmex America Inc.; THERAKOS Inc.; Vidacare Corporation; ViraCor Laboratories; ViroPharma Inc.; and Wellpoint Inc.

Keywords:

  • Technology adoption/diffusion/use
  • hospitals
  • clinical practice patterns/guidelines/resource use/evidence-based practice

Abandonment of High-Dose Chemotherapy/Hematopoietic Cell Transplants for Breast Cancer Following Negative Trial Results

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Journal Title:

Health Services Research

Volume:

Volume 46, Number 6 Pt 1

Publisher:

, Pages 1762-1777

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Objective In 1999, three randomized controlled trials concluded that high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (HDC/HCT) is no better than conventional chemotherapy for women with breast cancer. This study documents the impact of the trials on use of HDC/HCT and describes how hospitals reacted to the trials. Data Source We used patient-level data on 15,847 HDC/HCTs reported to the Center for International Blood and Marrow Transplant Research between 1994 and 2005. Study Design We report trends in total HDC/HCT procedure volume, compare the time to hospitals' exit from the HDC/HCT market between research and nonresearch hospitals, and document trends in hospital-specific volumes in the 2 years before exit. Principal Findings HDC/HCT volume declined from 3,108 in 1998 to 1,363 the year after trial results were released. In 2002, only 76 procedures were performed. Teaching hospitals and the hospitals that participated in the trials were no slower to discontinue the procedure compared with nonteaching, nonparticipating hospitals. At the hospital level, volume declined steadily in the months before abandonment. Conclusion The results suggest that comparative effectiveness research studies that report negative results can reduce spending, but specialists may be reluctant to relinquish cutting-edge technologies.

Copyright information:

© Health Research and Educational Trust

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