Abandonment of High-Dose Chemotherapy/Hematopoietic Cell Transplants for Breast Cancer Following Negative Trial Results
Abandonment of High-Dose Chemotherapy/Hematopoietic Cell Transplants for Breast Cancer Following Negative Trial Results
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DOI：
10.1111/j.1475-6773.2011.01296.x
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发表时间：
2011-12-01
影响因子：
3.4
通讯作者：
Majhail, Navneet S.
中科院分区：
文献类型：
--
作者：
Howard, David H.;Kenline, Carolyn;Majhail, Navneet S.
objective. 1999年，三项随机对照试验得出结论，高剂量化疗后自体造血干细胞移植（HDC/HCT）对乳腺癌妇女的疗效并不比常规化疗好。本研究记录了试验对HDC/HCT使用的影响，并描述了医院对试验的反应。数据来源。我们使用了1994年至2005年间向国际血液和骨髓移植研究中心报告的15，847例HDC/HCT的患者水平数据。我们报告了总HDC/HCT手术量的趋势，比较了研究医院和非研究医院从HDC/HCT市场退出的时间，并记录了退出前2年内医院特定手术量的趋势。HDC/HCT的数量从1998年的3,108例下降到试验结果公布后的1,363例。2002年，仅进行了76次手术。教学医院和参与试验的医院与非教学、非参与医院相比，停止手术的速度并不慢。在医院层面，数量稳步下降前几个月放弃。结论。结果表明，报告负面结果的比较有效性研究可以减少支出，但专家可能不愿意放弃尖端技术。
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.