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

项目概要/摘要：21世纪初DNA测序的快速发展为以下领域铺平了道路： 精准医疗-一种考虑到差异的量身定制疾病预防和治疗方法 基因、环境和生活方式。今天每天有十多个基因测试进入市场， 从帮助预测药物反应的测试到预测疾病风险的测试。然而，相对而言， 关于精准医疗在多大程度上已经扩散到临床实践中，以及对 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， 仅在2018年就接收了254，744人，最近有多种技术可供使用 给病人。最早进入市场的精准医疗工具之一是基因组测试， 决定对患者进行化疗（OncotypeDX）。从历史上看，大多数女性 早期乳腺癌患者将接受化疗，并接受基因组指导的治疗，只有女性可能会接受化疗。 以医疗保险为例，建议的总体目标是 项目的目的是了解供应商采用技术的障碍和促进因素， 技术应用对医疗系统的影响。为了实现这一目标，拟议的研究 具体目的是：（1）确定OncotypeDX的引入对提供者实践模式，患者 健康和医疗保健支出，（2）探索采用提供者的特点，（3）探索 来自340 B药品定价计划的供应商技术采用的财务激励措施。下 第一个目标，交错差异设计将用于估计供应商的因果影响 技术采用。对于第二个目标，供应商技术采用的关键特征将是 以及采用不足的决定因素。在第三个目标下，财政激励措施在以下方面的作用： 将使用340 B计划产生的变化来估计采用不足。拟建项目 创新，因为它使用了新颖的经验设计来估计技术采用的因果效应， 这是一种未被充分研究的技术的人口水平。这项研究意义重大，因为它 提供了深入了解提供者在精准医疗对医疗保健的扩散和影响中的作用 系统，以及在何种程度上扩散是有效和公平的。确定决定因素 供应商采用技术的情况可能成为信息和教育运动的有效目标。的 拟议的项目与医疗保健研究和质量机构（AHRQ）的研究优先事项保持一致， 提高卫生保健的可负担性和效率。

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.