Diffusion of Bevacizumab Across Oncology Practices: An Observational Study

• Published in: Medical care 2018-01, Vol.56 (1), p.69-77
• Main Authors: Keating, Nancy L, Huskamp, Haiden A, Schrag, Deborah, McWilliams, John M, McNeil, Barbara J, Landon, Bruce E, Chernew, Michael E, Normand, Sharon-Lise T
• Format: Article
• Language: English
• Subjects: Aged; Antineoplastic Agents, Immunological - therapeutic use; Bevacizumab; Bevacizumab - therapeutic use; Cancer; Cancer therapies; Chemotherapy; Confidence intervals; Diffusion; Fee-for-Service Plans - statistics & numerical data; Female; Government programs; Health care; Humans; Immunotherapy; Male; Medical Oncology - statistics & numerical data; Medicare; Medicare - statistics & numerical data; Monoclonal antibodies; Neoplasms - drug therapy; Observational studies; Odds Ratio; Oncology; Population studies; Practice Patterns, Physicians' - statistics & numerical data; Prescription drugs; Research design; Statistical analysis; Targeted cancer therapy; United States; Variation
• ISSN: 0025-7079; 1537-1948
• DOI: 10.1097/MLR.0000000000000840

BACKGROUND:Technological 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. OBJECTIVES:Examine 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 DESIGN:Population-based observational study. SETTING:A total of 2329 US practices providing cancer chemotherapy. PARTICIPANTS:Random 20% sample of 236,304 Medicare fee-for-service beneficiaries aged above 65 years in 2004–2012 undergoing infused chemotherapy for cancer. MEASURES:Diffusion 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. RESULTS:We 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)]. CONCLUSIONS:Use 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.