Address correspondence to David H. Howard, Ph.D., Department of Health Policy and Management, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322; e-mail: firstname.lastname@example.org. Carolyn Kenline, M.S., is with the Department of Health Policy and Management, Emory University, Atlanta, GA. Hillard M. Lazarus, M.D., is with the University Hospitals Case Medical Center, Case Comprehensive Cancer, Cleveland, OH. Charles F. LeMaistre, M.D., is with the Texas Institute of Medicine and Surgery, San Antonio, TX. Richard T. Maziarz, M.D., is with the Adult Blood and Marrow Stem Cell Transplant Program, Oregon Health and Science University, Portland, OR. Philip L. McCarthy Jr., M.D., is with the Blood and Marrow Transplant Program, Roswell Park Cancer Institute, Buffalo, NY. Susan K. Parsons, M.D., M.R.P., is with The Health Institute, ICRHPS, Tufts Medical Center, Boston, MA. David Szwajcer is with the Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. J. Douglas Rizzo, M.D., M.S., is with the CIBMTR, Froedtert and the Medical College of Wisconsin Clinical Cancer Center, Milwaukee, WI. Navneet S. Majhail, M.D., M.S., is with the Masonic Cancer Center, University of Minnesota, Minneapolis, MN.
Abandonment of High-Dose Chemotherapy/Hematopoietic Cell Transplants for Breast Cancer Following Negative Trial Results
Article first published online: 25 JUL 2011
© Health Research and Educational Trust
Health Services Research
Volume 46, Issue 6pt1, pages 1762–1777, December 2011
How to Cite
Howard, D. H., Kenline, C., Lazarus, H. M., LeMaistre, C. F., Maziarz, R. T., McCarthy Jr., P. L., Parsons, S. K., Szwajcer, D., Douglas Rizzo, J. and Majhail, N. S. (2011), Abandonment of High-Dose Chemotherapy/Hematopoietic Cell Transplants for Breast Cancer Following Negative Trial Results. Health Services Research, 46: 1762–1777. doi: 10.1111/j.1475-6773.2011.01296.x
- Issue published online: 16 NOV 2011
- Article first published online: 25 JUL 2011
- Technology adoption/diffusion/use;
- clinical practice patterns/guidelines/resource use/evidence-based practice
Objective. In 1999, three randomized controlled trials concluded that high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (HDC/HCT) is no better than conventional chemotherapy for women with breast cancer. This study documents the impact of the trials on use of HDC/HCT and describes how hospitals reacted to the trials.
Data Source. We used patient-level data on 15,847 HDC/HCTs reported to the Center for International Blood and Marrow Transplant Research between 1994 and 2005.
Study Design. We report trends in total HDC/HCT procedure volume, compare the time to hospitals' exit from the HDC/HCT market between research and nonresearch hospitals, and document trends in hospital-specific volumes in the 2 years before exit.
Principal Findings. HDC/HCT volume declined from 3,108 in 1998 to 1,363 the year after trial results were released. In 2002, only 76 procedures were performed. Teaching hospitals and the hospitals that participated in the trials were no slower to discontinue the procedure compared with nonteaching, nonparticipating hospitals. At the hospital level, volume declined steadily in the months before abandonment.
Conclusion. The results suggest that comparative effectiveness research studies that report negative results can reduce spending, but specialists may be reluctant to relinquish cutting-edge technologies.