Therapeutic substitutions in the midst of new technology diffusion: The case of treatment for localized prostate cancer.
Therapeutic substitutions in the midst of new technology diffusion: The case of treatment for localized prostate cancer.
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新技术传播中的治疗替代：局部前列腺癌的治疗案例。
DOI：
10.1016/j.socscimed.2016.01.016
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
TinaShih,Ya-Chen
中科院分区：
文献类型：
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作者：
Shen,Chan;TinaShih,Ya-Chen
机器人手术系统在世界范围内越来越受欢迎。机器人辅助根治性前列腺癌切除术已被广泛用于治疗局限性前列腺癌，取代传统的开放手术。然而，目前尚不清楚这是否是通过在相同的治疗类型（即，用机器人辅助手术代替开放手术）或在治疗类型之间进行替代（即，扩大了接受手术的患者比例，同时排挤了局部前列腺癌的其他形式的治疗）。鉴于每年接受这些手术的患者数量庞大，研究机器人手术系统的快速普及对局部前列腺癌整体治疗模式的影响非常重要。我们使用从2002年至2010年国家癌症数据库中提取的州级癌症流行病学数据（256个观察结果）和从区域资源文件中获得的供应方变量（例如机器人手术系统的密度，泌尿科医生）以及发布在机器人手术系统制造商网站上的投资者演示文稿来解决这个问题。认识到机器人系统的购买决策是潜在的内生性，我们使用了最优工具变量面板估计方法来检查的影响，同时考虑到面板结构和机器人手术系统的密度及其二次项的潜在内生性。我们发现，州一级机器人系统的密度对手术率有显著的积极影响，对放射治疗率有显著的消极影响。此外，我们的年龄分层分析显示，手术率的增加在年轻人群中最为明显。总之，我们的研究结果表明，手术率的增加部分是由于治疗类型的替代，其中很大一部分来自年轻人群。
Robotic surgical systems have become increasingly popular worldwide. Robotic assisted radical prostatectomies have been widely adopted in the treatment of localized prostate cancer, replacing the conventional open surgeries. However, it is not clear whether this was achieved by substitution within the same treatment type (i.e., replacing open surgeries with robotic-assisted surgeries) or substitution across treatment types (i.e., expanding the proportion of patients receiving surgery while crowding out other forms of treatment for localized prostate cancer). Given the large number of patients undergoing these procedures each year, it is important to study the impact of the fast diffusion of robotic surgical systems on the overall treatment pattern of localized prostate cancer. We addressed this question using state-level cancer epidemiology data (256 observations) extracted from 2002 to 2010 National Cancer Database, and supply-side variables (e.g. density of robotic surgical systems, urologists) obtained from Area Resource File as well as investor presentations posted at the website of the manufacturer of robotic surgical systems. Recognizing that the purchase decision of robotic systems is potentially endogenous, we used an optimal instrumental variables panel estimation method to examine the impact while taking into account of the panel structure and the potential endogeneity of the density of robotic surgical systems and its quadratic term. We found that the density of robotic systems at state-level had a significantly positive impact on the rate of surgery and a significantly negative impact on the rate of radiation therapy. Further, our age-stratified analysis showed that the increase in surgery rate was most pronounced in the younger population. In conclusion, our findings suggest that part of the increase in the rate of surgery was driven by substitution across treatment types with a large proportion originating from the younger population.