Certificate of Need Regulations and the Diffusion of Intensity-modulated Radiotherapy - 30/10/12
, Yun Zhang b, Ted A. Skolarus a, b, c, John T. Wei a, d, James E. Montie a, b, Florian R. Schroeck a, b, Brent K. Hollenbeck a, b
Reprint requests: Bruce L. Jacobs, M.D., M.P.H., Department of Urology, University of Michigan, Building 520, Third Floor, 2800 Plymouth Road, Ann Arbor, MI 48109-2800Résumé |
Objective |
To better understand the associations between the certificate of need regulations and intensity-modulated radiotherapy dissemination.
Methods |
Using Surveillance, Epidemiology, and End Results-Medicare data, we identified men (aged ≥66 years) treated with radiotherapy for prostate cancer who had been diagnosed from 2001 to 2007. Using data from the American Health Planning Association, we sorted the health service areas (HSAs) according to the stringency of certificate of need regulations (low vs high) in that market. We assessed our outcomes (ie, the probability of intensity-modulated radiotherapy adoption and intensity-modulated radiotherapy use in the HSAs) using Cox proportional hazards and Poisson regression models, respectively.
Results |
The low- and high-stringency markets were similar in terms of racial composition (80% vs 85% white, P = .08), population density (1085 vs 558 people/square mile, P = .08), and income (median $38 683 vs $40 309, P = .44). However, the low-stringency markets had more patients with stage T1 disease (45% vs 36%, P < .01). The probability of intensity-modulated radiotherapy adoption across the 2 groups of HSAs was similar (P = .65). However, among the adopting HSAs, those with high stringency consistently had greater use of intensity-modulated radiotherapy (P < .01).
Conclusion |
The certificate of need regulations fail to create significant barriers to entry for intensity-modulated radiotherapy. Among the HSAs that acquired intensity-modulated radiotherapy, high-stringency markets demonstrated a greater propensity for using intensity-modulated radiotherapy. These findings raise questions regarding the ability of the certificate of need regulations to control technology dissemination.
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| Financial Disclosure: The authors declare that they have no relevant financial interests. |
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| Funding Support: B. J. is supported in part by the American Cancer Society Postdoctoral Fellowship Grant 121805-PF-12-008-01-CPHPS; B.J. and F.S. are supported in part by the National Institutes of Health Training (grant NIH 5 T32 DK007782-12); B. H. is supported in part by the American Cancer Society Pennsylvania Division—Dr. William and Rita Conrady Mentored Research Scholar Grant (grant MSRG-07-006-01-CPHPS), American Urological Association Foundation, and Astellas Pharma US, Inc. |
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| The views expressed in this article do not reflect the views of the U.S. federal government. |
Vol 80 - N° 5
P. 1015-1020 - novembre 2012 Retour au numéro
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