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

项目总结 癌症是美国第二大死因，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 到2020年达到1,580亿美元。美国医学研究所最近一份题为《提供高质量的癌症护理： 为处于危机中的系统绘制新的路线“，表达了对不可持续的增长的主要关切 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。这项拟议研究的目的是检查技术扩散在医疗、 放射治疗和外科肿瘤学对癌症护理的成本和结果的影响。 这项研究的具体目标是：(1)描述医疗、放射和医疗领域的技术扩散模式 最昂贵的五种癌症中的外科肿瘤学，并评估扩散的地理差异 模式；(2)审查与新技术传播有关的因素以及那些有助于 新技术扩散的地域差异；(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遵守指南是否会改变这种影响； 以及(4)评估肿瘤新技术的普及对癌症护理成本的影响，以及 医疗保健支出的地理差异，并探索这些新技术是否适用于每种癌症 是现有治疗的替代或补充。我们将使用队列来解决我们的研究问题 从SEER-Medicare和MarketScan数据库中提取的癌症患者的数量，重点放在前五名 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。 我们的研究将对所有形式的技术传播的现状进行全面评估 参与癌症的治疗，特别关注与市场和组织特征挂钩的 供应商的经济激励。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的复杂相互作用，并使我们能够探索 新技术的替代或互补效应，无论是在同一技术类别内还是在 上课。我们的研究结果将有助于政策制定者设计和规划传播和 实施战略，以最大限度地发挥有效新疗法的效益，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.