The Causes and Consequences of the Diffusion of Precision Medicine: Evidence from Innovations in Breast Cancer Medicine

精准医学传播的原因和后果：来自乳腺癌医学创新的证据

• 批准号: 10616989
• 负责人: Jasmin Moshfegh
• 金额: $ 4.21万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10616989
• 关键词: Causes; Consequences; Diffusion; Precision; Medicine

Project Summary/Abstract: Rapid advancements in DNA sequencing in the early 2000s paved the way for precision medicine - an approach to tailor disease prevention and treatment while taking into account differences in people’s genes, environments, and lifestyles. Today more than ten genetic tests enter the market every day, ranging from tests that help predict drug response to tests that predict disease risk. Yet, relatively little is known about the extent to which precision medicine has diffused into clinical practice and the consequences on the healthcare system. The proposed project studies this question in the context of breast cancer, a diagnosis which 254,744 individuals received in 2018 alone, and for which multiple technologies have recently become available to patients. One of the earliest precision medicine tools to reach the market was a genomic test that personalized the decision to administer chemotherapy to a patient (OncotypeDX). While historically, the majority of women with early-stage breast cancer would receive chemotherapy, with genomic-guided care, only women likely to benefit from chemotherapy would receive it. Using Medicare as an example, the overall objective of the proposed project is to understand the barriers to and facilitators of technological adoption by providers, and the consequences of technological adoption on the healthcare system. To accomplish this, the proposed research specifically aims to: (1) identify the effect of the introduction of OncotypeDX on provider practice patterns, patient health, and healthcare spending, (2) explore the characteristics of adopting providers, and (3) explore the role of financial incentives in provider technological adoption stemming from the 340B drug pricing program. Under the first aim, a staggered difference-in-difference design will be used to estimate the causal impact of provider technological adoption. For the second aim, key characteristics of provider technological adoption will be identified as well as the determinants of under-adoption. Under the third aim, the role of financial incentives in under-adoption will be estimated using variation stemming from the 340B program. The proposed project is innovative because it is uses novel empirical designs to estimate the causal effect of technological adoption at the population-level for an understudied class of technologies. The research proposed is significant because it provides insight into the role of providers in the diffusion and impact of precision medicine on the healthcare system, as well as the extent to which diffusion has been efficient and equitable. Identification of the determinants of provider technological adoption may point to effective targets for information and education campaigns. The proposed project aligns well with the Agency for Healthcare Research and Quality’s (AHRQ) research priority to increase the affordability and efficiency of health care.

项目摘要/摘要：2000 年代初 DNA 测序技术的快速进步为 精准医疗——一种在考虑差异的同时定制疾病预防和治疗的方法 存在于人们的基因、环境和生活方式中。如今每天都有十多种基因测试进入市场， 范围从帮助预测药物反应的测试到预测疾病风险的测试。然而，人们知之甚少 关于精准医学在临床实践中的传播程度及其对临床实践的影响 医疗保健系统。拟议的项目在乳腺癌的背景下研究这个问题，乳腺癌的诊断 仅 2018 年就接收了 254,744 人，最近已推出多种技术 给患者。最早进入市场的精准医疗工具之一是基因组测试，它可以个性化 对患者进行化疗的决定 (OncotypeDX)。虽然从历史上看，大多数女性 患有早期乳腺癌的患者将接受化疗，通过基因组指导护理，只有女性才可能接受 受益于化疗会收到它。以医疗保险为例，拟议的总体目标 该项目的目的是了解提供商采用技术的障碍和促进因素，以及 技术采用对医疗保健系统的影响。为了实现这一目标，拟议的研究 具体目标是：(1) 确定引入 OncotypeDX 对提供者实践模式、患者的影响 健康和医疗支出，(2) 探索采用提供者的特征，(3) 探索其作用 340B 药品定价计划对提供商技术采用的经济激励。在下面 第一个目标，将使用交错双重差分设计来估计提供者的因果影响 技术采用。对于第二个目标，提供商技术采用的关键特征将是 确定了收养不足的决定因素。在第三个目标下，财政激励的作用 将使用 340B 计划产生的变化来估计采用不足的情况。拟议项目是 创新，因为它使用新颖的经验设计来估计技术采用的因果效应 未充分研究的技术类别的人口水平。所提出的研究意义重大，因为它 深入了解医疗服务提供者在精准医疗的传播和对医疗保健的影响方面的作用 体系，以及传播的有效和公平程度。确定决定因素 提供商技术采用的情况可能会为信息和教育活动指明有效的目标。这 拟议的项目与医疗保健研究和质量机构 (AHRQ) 的研究重点非常一致 提高医疗保健的负担能力和效率。