Diffusion of new technology in health care: the case of aorto-iliac occlusive disease.
BACKGROUND
The objective of the current study was to characterize temporal trends in the treatment of aorto-iliac occlusive disease (AIOD) and the impact of the introduction of less invasive therapy on overall intervention rates.


METHODS
Patients with diagnostic codes for AIOD, and procedure codes for aortofemoral bypass (AFB) or iliac artery angioplasty and stenting were selected from the Nationwide Inpatient Sample for 1996 to 2000. Utilization rates of both intervention types were determined. Outcome variables including in-hospital mortality and duration of stay were assessed.


RESULTS
The rate of iliac artery angioplasty and stenting increased 850%, from 0.4 to 3.4 cases per 100,000 adults (P <.001). The rate of AFB declined 15.5%, from 5.8 to 4.9 cases per 100,000 adults (P <.005). Older age, white race, and higher-income patients were more likely to undergo angioplasty and stenting. AFB had a higher mortality rate, longer duration of stay, and higher hospital charges compared to angioplasty and stenting.


CONCLUSIONS
Iliac artery angioplasty and stenting has rapidly gained a large market share in the treatment of AIOD. Acceptable clinical outcomes have likely lowered the threshold for treatment and contributed to the rapid diffusion of this technology for the treatment of AIOD.
Upchurch
Gilbert R
GR
Surgical Outcomes Research Team (SORT), Section of Vascular Surgery, University of Michigan Medical Center, Ann Arbor, MI 48109-0329, USA.
Dimick
Justin B
JB
Wainess
Reid M
RM
Eliason
Jonathan L
JL
Henke
Peter K
PK
Cowan
John A
JA
Eagleton
Matthew J
MJ
Srivastava
Sunita D
SD
Stanley
James C
JC
D000368:Aged; D000800:Angioplasty, Balloon / Q000706:statistics & numerical data*; D001011:Aorta / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D020811:Biomedical Technology / Q000639:trends; D019917:Blood Vessel Prosthesis Implantation / Q000706:statistics & numerical data*; D005260:Female; D019981:Health Care Sector; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000706:statistics & numerical data; D018581:Technology Transfer; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology