title: Comparative effectiveness research, technological abandonment, and health care spending.
abstract: OBJECTIVE
  Policymakers hope that comparative effectiveness research will identify examples of widely used therapies that are no better than less expensive alternatives and, consequently, reduce health care spending. Comparative effectiveness research is unlikely to reduce spending if physicians are quick to adopt effective treatments but slow to abandon ineffective ones.
  
  
  METHODS
  We present a theoretical model that shows how physicians will adopt new treatments in response to positive evidence more readily than they abandon existing treatments in response to negative evidence if the marginal costs of production decline post-adoption. We report trends in the use of two common procedures, percutaneous coronary intervention (PCI) for patients with stable angina and routine episiotomy in vaginal childbirth, where comparative effectiveness research studies have failed to find evidence of a benefit.
  
  
  RESULTS
  Use of PCI and episiotomy have declined over time but are still excessive based on the standards implied by comparative effectiveness research. PRACTICAL IMPLICATIONS (IF APPLICABLE): The findings suggest that comparative effectiveness research has the potential to reduce costs but additional efforts are necessary to fully realize savings from abandonment.
  
  
  CONCLUSIONS
  There is a large literature on technological adoption in health care, but few studies address technological abandonment. Understanding abandonment is important for efforts to decrease health care costs by reducing use of ineffective but costly treatments.
authors.affiliation: Department of Health Policy and Management, Emory University, Atlanta, GA, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Howard
authors.forename: Yu-Chu
authors.initials: YC
authors.lastname: Shen
mesh_terms: D020811:Biomedical Technology; D057186:Comparative Effectiveness Research; D004059:Diffusion of Innovation; D004841:Episiotomy / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005260:Female; D005102:Health Expenditures; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D014481:United States