Comparative effectiveness research, COURAGE and technological abandonment

Abstract

When a major study finds that a widely used medical treatment is no better than a less expensive one, 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 voume post-COURAGE. However, many patients with stable angina continue to receive PCI. We do not find differences in PCU volume trends by reimbursement schemes or hospitals' teaching status, ownership, or degree of vertical integration.