TY  - JOUR
AU  - Howard,David H.
AU  - Shen,Yu-Chu
TI  - Comparative Effectiveness Research, COURAGE, and Technological Abandonment
JF  - National Bureau of Economic Research Working Paper Series
VL  - No. 17371
PY  - 2011
Y2  - August 2011
UR  - http://www.nber.org/papers/w17371
L1  - http://www.nber.org/papers/w17371.pdf
N1  - Author contact info:
David Howard
Department of Health Policy and Management
Emory University
1518 Clifton Road NE
Atlanta, GA 30322
Tel: 404-727-3907
Fax: 404-727-9198
E-Mail: dhhowar@emory.edu

Yu-Chu Shen
Graduate School of Business and Public Policy
Naval Postgraduate School
555 Dyer Road
Monterey, CA 93943
Tel: 831/656-2951
E-Mail: yshen@nps.edu
AB  - 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.
ER  -