NATIONAL BUREAU OF ECONOMIC RESEARCH
NATIONAL BUREAU OF ECONOMIC RESEARCH

Comparative Effectiveness Research, COURAGE, and Technological Abandonment

David H. Howard, Yu-Chu Shen

NBER Working Paper No. 17371
Issued in August 2011
NBER Program(s):   HC

When a major study finds that a widely used medical treatment is no better than a less expensive alternative, do physicians stop using it? Policymakers hope that comparative effectiveness research will identify less expensive substitutes for widely-used treatments, but physicians may be reluctant to abandon profitable therapies. We examine the impact of the COURAGE trial, which found that medical therapy is as effective as percutaneous coronary intervention (PCI) for patients with stable angina, on practice patterns. Using hospital discharge data from US community, Veterans Administration, and English hospitals, we detect a moderate decline in PCI volume post-COURAGE. However, many patients with stable angina continue to receive PCI. We do not find differences in PCI volume trends by reimbursement scheme or hospitals’ teaching status, ownership, or degree of vertical integration.

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Document Object Identifier (DOI): 10.3386/w17371

Published: Howard, D. and Shen, Y. 2012. Comparative Effectiveness Research, Technological Abandonment, and Health Care Spending. Advances in Health Economics and Health Services Research, Volume 23: 103-121.

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