• Nancy L Keating, Haiden A Huskamp, Deborah Schrag, John M McWilliams, Barbara J McNeil, Bruce E Landon, Michael E Chernew, and NormandSharon-Lise TSTDepartment of Health Care Policy, Harvard Medical School.Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA..
• Department of Health Care Policy, Harvard Medical School.
• Med Care. 2018 Jan 1; 56 (1): 69-77.

BackgroundTechnological advances can improve care and outcomes but are a primary driver of health care spending growth. Understanding diffusion and use of new oncology therapies is important, given substantial increases in prices and spending on such treatments.ObjectivesExamine diffusion of bevacizumab, a novel (in 2004) and high-priced biologic cancer therapy, among US oncology practices during 2005-2012 and assess variation in use across practices.Research DesignPopulation-based observational study.SettingA total of 2329 US practices providing cancer chemotherapy.ParticipantsRandom 20% sample of 236,304 Medicare fee-for-service beneficiaries aged above 65 years in 2004-2012 undergoing infused chemotherapy for cancer.MeasuresDiffusion of bevacizumab (cumulative time to first use and 10% use) in practices, variation in use across practices overall and by higher versus lower-value use. We used hierarchical models with practice random effects to estimate the between-practice variation in the probability of receiving bevacizumab and to identify factors associated with use.ResultsWe observed relatively rapid diffusion of bevacizumab, particularly in independent practices and larger versus smaller practices. We observed substantial variation in use; the adjusted odds ratio (95% confidence interval) of bevacizumab use was 2.90 higher (2.73-3.08) for practices 1 SD above versus one standard deviation below the mean. Variation was less for higher-value [odds ratio=2.72 (2.56-2.89)] than lower-value uses [odds ratio=3.61 (3.21-4.06)].ConclusionsUse of bevacizumab varied widely across oncology practices, particularly for lower-value indications. These findings suggest that interventions targeted to practices have potential for decreasing low-value use of high-cost cancer therapies.

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