Diffusion of Bevacizumab Across Oncology Practices: An Observational Study

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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.

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