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Grant Details

Grant Number: 5R01CA207216-04 Interpret this number
Primary Investigator: Shih, Ya-Chen
Organization: University Of Tx Md Anderson Can Ctr
Project Title: Technology Diffusion in Cancer: Geographic Variations, Facilitators, Outcomes, and Costs
Fiscal Year: 2019
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Abstract

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.

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Publications

Trends in Volume-Outcome Relationship in Gastrectomies in Texas.
Authors: Ikoma N. , Kim B. , Elting L.S. , Shih Y.T. , Badgwell B.D. , Mansfield P. .
Source: Annals of surgical oncology, 2019 Sep; 26(9), p. 2694-2702.
EPub date: 2019-07-01.
PMID: 31264116
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Treatment value of second-generation BCR-ABL1 tyrosine kinase inhibitors compared with imatinib to achieve treatment-free remission in patients with chronic myeloid leukaemia: a modelling study.
Authors: Shih Y.T. , Cortes J.E. , Kantarjian H.M. .
Source: The Lancet. Haematology, 2019 Aug; 6(8), p. e398-e408.
EPub date: 2019-06-14.
PMID: 31208943
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Rising Economic Burden of Renal Cell Carcinoma among Elderly Patients in the USA: Part II-An Updated Analysis of SEER-Medicare Data.
Authors: Shih Y.T. , Xu Y. , Chien C.R. , Kim B. , Shen Y. , Li L. , Geynisman D.M. .
Source: PharmacoEconomics, 2019-07-08; , .
EPub date: 2019-07-08.
PMID: 31286464
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Outcomes of Curative-Intent Treatment for Patients With Breast Cancer Presenting With Sternal or Mediastinal Involvement.
Authors: Christopherson K. , Lei X. , Barcenas C. , Buchholz T.A. , Garg N. , Hoffman K.E. , Kuerer H.M. , Mittendorf E. , Perkins G. , Shaitelman S.F. , et al. .
Source: International journal of radiation oncology, biology, physics, 2019-07-01; 104(3), p. 574-581.
EPub date: 2019-03-06.
PMID: 30851348
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Trends in Radiation for Bone Metastasis During a Period of Multiple National Quality Improvement Initiatives.
Authors: Logan J.K. , Jiang J. , Shih Y.T. , Lei X. , Xu Y. , Hoffman K.E. , Giordano S.H. , Smith B.D. .
Source: Journal of oncology practice, 2019 Apr; 15(4), p. e356-e368.
EPub date: 2019-03-08.
PMID: 30849005
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Do Internal Mammary Nodes Matter?
Authors: Caudle A.S. , Smith B.D. .
Source: Annals of surgical oncology, 2019 Apr; 26(4), p. 930-932.
EPub date: 2019-01-07.
PMID: 30617872
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The concomitant use of tyrosine kinase inhibitors and proton pump inhibitors: Prevalence, predictors, and impact on survival and discontinuation of therapy in older adults with cancer.
Authors: Sharma M. , Holmes H.M. , Mehta H.B. , Chen H. , Aparasu R.R. , Shih Y.T. , Giordano S.H. , Johnson M.L. .
Source: Cancer, 2019-04-01; 125(7), p. 1155-1162.
EPub date: 2019-01-03.
PMID: 30605231
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Comparative Effectiveness of Computed Tomography- Versus Ultrasound-Guided Percutaneous Radiofrequency Ablation Among Medicare Patients 65 Years of Age or Older With Hepatocellular Carcinoma.
Authors: Huo J. , Aloia T.A. , Xu Y. , Chung T.H. , Sheu T. , Tina Shih Y.C. .
Source: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2019 Mar; 22(3), p. 284-292.
EPub date: 2018-11-27.
PMID: 30832966
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Complication Rates and Downstream Medical Costs Associated With Invasive Diagnostic Procedures for Lung Abnormalities in the Community Setting.
Authors: Huo J. , Xu Y. , Sheu T. , Volk R.J. , Shih Y.T. .
Source: JAMA internal medicine, 2019-03-01; 179(3), p. 324-332.
PMID: 30640382
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Economic Burden of Renal Cell Carcinoma-Part I: An Updated Review.
Authors: Chien C.R. , Geynisman D.M. , Kim B. , Xu Y. , Shih Y.T. .
Source: PharmacoEconomics, 2019 Mar; 37(3), p. 301-331.
PMID: 30467701
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Three-Year Outcomes With Hypofractionated Versus Conventionally Fractionated Whole-Breast Irradiation: Results of a Randomized, Noninferiority Clinical Trial.
Authors: Shaitelman S.F. , Lei X. , Thompson A. , Schlembach P. , Bloom E.S. , Arzu I.Y. , Buchholz D. , Chronowski G. , Dvorak T. , Grade E. , et al. .
Source: Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-10-31; , p. JCO1800317.
EPub date: 2018-10-31.
PMID: 30379626
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Trends in breast cancer mortality by stage at diagnosis among young women in the United States.
Authors: Guo F. , Kuo Y.F. , Shih Y.C.T. , Giordano S.H. , Berenson A.B. .
Source: Cancer, 2018-09-01; 124(17), p. 3500-3509.
EPub date: 2018-09-06.
PMID: 30189117
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Cost Analysis of PET/CT Versus CT as Surveillance for Stage III Non-Small-Cell Lung Cancer After Definitive Radiation Therapy.
Authors: Kim C.R. , Kim B. , Ning M.S. , Reddy J.P. , Liao Z. , Tang C. , Welsh J.W. , Mott F.E. , Shih Y.T. , Gomez D.R. .
Source: Clinical lung cancer, 2018 07; 19(4), p. e517-e528.
EPub date: 2018-03-17.
PMID: 29685701
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Comparative Toxicities and Cost of Intensity-Modulated Radiotherapy, Proton Radiation, and Stereotactic Body Radiotherapy Among Younger Men With Prostate Cancer.
Authors: Pan H.Y. , Jiang J. , Hoffman K.E. , Tang C. , Choi S.L. , Nguyen Q.N. , Frank S.J. , Anscher M.S. , Shih Y.T. , Smith B.D. .
Source: Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-06-20; 36(18), p. 1823-1830.
EPub date: 2018-03-21.
PMID: 29561693
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Long-term Patient-Reported Outcomes in Older Breast Cancer Survivors: A Population-Based Survey Study.
Authors: Swanick C.W. , Lei X. , Xu Y. , Shen Y. , Goodwin N.A. , Smith G.L. , Giordano S.H. , Hunt K.K. , Jagsi R. , Shaitelman S.F. , et al. .
Source: International journal of radiation oncology, biology, physics, 2018-03-15; 100(4), p. 882-890.
EPub date: 2017-12-09.
PMID: 29485067
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Price Transparency for Whom? In Search of Out-of-Pocket Cost Estimates to Facilitate Cost Communication in Cancer Care.
Authors: Shih Y.T. , Nasso S.F. , Zafar S.Y. .
Source: PharmacoEconomics, 2018 03; 36(3), p. 259-261.
PMID: 29396743
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Adherence to tyrosine kinase inhibitors among Medicare Part D beneficiaries with chronic myeloid leukemia.
Authors: Shen C. , Zhao B. , Liu L. , Shih Y.T. .
Source: Cancer, 2018-01-15; 124(2), p. 364-373.
EPub date: 2017-10-04.
PMID: 28976559
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Do Robotic Surgical Systems Improve Profit Margins? A Cross-Sectional Analysis of California Hospitals.
Authors: Shih Y.T. , Shen C. , Hu J.C. .
Source: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2017 09; 20(8), p. 1221-1225.
EPub date: 2017-06-20.
PMID: 28964456
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Association Between Quality of Care for Breast Cancer and Health Insurance Exchange Coverage: An Analysis of Use of Radiation Therapy After Breast-Conserving Surgery.
Authors: Shih Y.T. , Xu Y. , Chavez-MacGregor M. , Guadagnolo B.A. , Smith B.D. , Giordano S.H. .
Source: JAMA oncology, 2017-10-01; 3(10), p. 1425-1426.
PMID: 28570719
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Rising Prices of Targeted Oral Anticancer Medications and Associated Financial Burden on Medicare Beneficiaries.
Authors: Shih Y.T. , Xu Y. , Liu L. , Smieliauskas F. .
Source: Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-08-01; 35(22), p. 2482-2489.
EPub date: 2017-05-04.
PMID: 28471711
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Influence of Age on Guideline-Concordant Cancer Care for Elderly Patients in the United States.
Authors: Fang P. , He W. , Gomez D.R. , Hoffman K.E. , Smith B.D. , Giordano S.H. , Jagsi R. , Smith G.L. .
Source: International journal of radiation oncology, biology, physics, 2017-07-15; 98(4), p. 748-757.
EPub date: 2017-02-01.
PMID: 28366580
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Effects of Smoking on Late Toxicity From Breast Radiation.
Authors: Shaitelman S.F. , Howell R.M. , Smith B.D. .
Source: Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-05-20; 35(15), p. 1633-1635.
EPub date: 2017-03-20.
PMID: 28319432
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A review of cost communication in oncology: Patient attitude, provider acceptance, and outcome assessment.
Authors: Shih Y.T. , Chien C.R. .
Source: Cancer, 2017-05-15; 123(6), p. 928-939.
EPub date: 2016-11-28.
PMID: 27893929
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Use of CT and Chest Radiography for Lung Cancer Screening Before and After Publication of Screening Guidelines: Intended and Unintended Uptake.
Authors: Huo J. , Shen C. , Volk R.J. , Shih Y.T. .
Source: JAMA internal medicine, 2017-03-01; 177(3), p. 439-441.
PMID: 28135349
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Chemotherapy First, Then Select for Local Therapy.
Authors: Smith B.D. .
Source: International journal of radiation oncology, biology, physics, 2017-03-01; 97(3), p. 449.
EPub date: 2016-10-26.
PMID: 28126297
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Financial Burden for Patients With Chronic Myeloid Leukemia Enrolled in Medicare Part D Taking Targeted Oral Anticancer Medications.
Authors: Shen C. , Zhao B. , Liu L. , Shih Y.T. .
Source: Journal of oncology practice, 2017 02; 13(2), p. e152-e162.
EPub date: 2017-01-17.
PMID: 28095170
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