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

• Authors: David H Howard, Emory University; Carolyn Kenline, Emory University; Hillard M Lazarus, Case Comprehensive Cancer Cleveland; Charles F LeMaistre, Texas Institute of Medicine and Surgery; Richard T Maziarz, Oregon Health and Science University; Philip L McCarthy, Roswell Park Cancer Institute; Susan K Parsons, Tufts Medical Center; David Szwajcer, University of Manitoba; James Douglas Rizzo, The Medical College of Wisconsin; Navneet S Majhail, University of Minnesota Minneapolis
• Journal Title: Health Services Research
• Volume: Volume 46, Number 6 Pt 1
• Publisher: Blackwell Science Inc | 2011-12, Pages 1762-1777
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1111/j.1475-6773.2011.01296.x
• Subjects: Health Sciences, Health Care Management
• Keywords: Technology adoption/diffusion/use; hospitals; clinical practice patterns/guidelines/resource use/evidence-based practice

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.