Working Paper: NBER ID: w17371
Authors: David H. Howard; Yuchu Shen
Abstract: 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.
Keywords: comparative effectiveness research; technological abandonment; percutaneous coronary intervention; Courage trial
JEL Codes: I11; O33
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Courage trial (C92) | PCI volume for patients with stable angina (G21) |
| Courage trial (C92) | practice patterns regarding PCI for stable angina (L42) |
| reimbursement structures (M52) | practice patterns regarding PCI (L42) |
| financial incentives favoring PCI (J32) | inertia in practice change (O31) |
| Courage trial (C92) | decline in PCI volume (F69) |