Technology Diffusion in Cancer: Geographic Variations, Facilitators, Outcomes, and Costs

项目摘要 癌症是美国第二大死亡原因，约占死亡人数的25%。 2010年，全国癌症医疗支出达到1250亿美元，预计将增加到1000亿美元。 到2020年1580亿美元。医学研究所最近的一份题为“提供高质量的癌症护理： 为处于危机中的系统制定新的路线，”对不可持续的增长表示严重关切， 癌症护理成本，确定新技术的快速传播和人口老龄化是关键成本 司机这项研究的目的是研究技术扩散在医疗、卫生和医疗保健领域的影响， 放射和外科肿瘤学对癌症护理的成本和结果的影响。 本研究的具体目的是：（1）描述医疗、放射和医疗领域的技术扩散模式， 前五名最昂贵的癌症中的外科肿瘤学，并评估扩散的地理差异 （2）研究与新技术的传播有关的因素，以及有助于促进新技术传播的因素。 新技术扩散的地理差异;（3）评估新技术扩散的影响 肿瘤学技术对健康结果的影响，以及是否会通过遵守指南来改变这种影响; 和（4）估计新肿瘤学技术的扩散对癌症护理成本的影响， 医疗保健支出的地理差异，并探索每种癌症是否这些新技术 替代或补充现有治疗。我们将使用队列来解决我们的研究问题， 从SEER-医疗保险和MarketScan数据库中提取的癌症患者，重点关注前五名 最昂贵的癌症：女性乳腺癌、结直肠癌、淋巴瘤、肺癌和前列腺癌。 我们的研究将提供一个全面的评估，目前的状态，技术扩散的所有形式 参与癌症治疗，特别注意与癌症相关的市场和组织特征， 供应商的财务激励。选择癌症来研究技术扩散提供了一个独特的机会， 了解新技术和现有技术之间复杂的相互作用，使我们能够探索 新技术的替代或互补效应，无论是在同一类技术， 班我们的研究结果将有助于政策制定者设计和规划传播， 实施战略，以最大限度地提高有效的新治疗的效益，同时考虑到 对癌症护理提供系统的成本影响。

PROJECT SUMMARY Cancer is the second leading cause of death in the United States, accounting for approximately 25% of deaths. The national medical expenditures of cancer reached $125 billion in 2010, and are projected to increase to $158 billion by 2020. A recent Institute of Medicine report, entitled “Delivering high-quality cancer care: Charting a new course for a system in crisis,” expressed major concerns over the unsustainable increase in the cost of cancer care, identifying rapid diffusion of new technologies and the aging demographic as key cost drivers. The objective of the proposed study is to examine the impact of technology diffusion in medical, radiation, and surgical oncology on the costs and outcomes of cancer care. Specific aims of the study are: (1) to describe the pattern of technology diffusion in medical, radiation, and surgical oncology in the top five most expensive cancers and assess the geographic variation of the diffusion pattern; (2) to examine factors associated with the diffusion of new technologies and those that contribute to the geographic variations in new technology diffusion; (3) to evaluate the impact of the diffusion of new oncologic technologies on health outcomes and whether the impact would be modified by guideline adherence; and (4) to estimate the effect of the diffusion of new oncologic technologies on the cost of cancer care and geographic variation in healthcare spending, and to explore for each cancer whether these new technologies are substitute or complementary to existing treatment. We will address our research questions using a cohort of cancer patients extracted from the SEER-Medicare and MarketScan databases, focusing on the top five most expensive cancers: female breast, colorectal, lymphoma, lung, and prostate cancer. Our study will provide a comprehensive evaluation of the current state of technology diffusion for all modalities involved in the treatment of cancer, paying special attention to market and organizational characteristics tied to providers’ financial incentives. The choice of cancer to study technology diffusion offers a unique opportunity to understand the complicated interactions between new and existing technologies and allows us to explore the substitution or complementary effect of new technologies, both within the same class of technology and across classes. Findings from our study will assist policy makers in the design and planning dissemination and implementation strategies to maximize the benefit of effective new treatments while taking into consideration of the cost implications to the cancer care delivery system.