@article{4e6220e53f0041f8831d9df391688b37,
title = "Uptake of evidence by physicians: De-adoption of erythropoiesis-stimulating agents after the TREAT trial",
abstract = "Background: Variation in de-adoption of ineffective or unsafe treatments is not well-understood. We examined de-adoption of erythropoiesis-stimulating agents (ESA) in anemia treatment among patients with chronic kidney disease (CKD) following new clinical evidence of harm and ineffectiveness (the TREAT trial) and the FDA{\textquoteright}s revision of its safety warning. Method: We used a segmented regression approach to estimate changes in use of epoetin alfa (EPO) and darbepoetin alfa (DPO) in the commercial, Medicare Advantage (MA) and Medicare fee-for-service (FFS) populations. We also examined how changes in both trends and levels of use were associated with physicians{\textquoteright} characteristics. Results: Use of DPO and EPO declined over the study period. There were no consistent changes in DPO trend across insurance groups, but the level of DPO use decreased right after the FDA revision in all groups. The decline in EPO use trend was faster after the TREAT trial for all groups. Nephrologists were largely more responsive to evidence than primary care physicians. Differences by physician{\textquoteright}s gender, and age were not consistent across insurance populations and types of ESA. Conclusions: Physician specialty has a dominant role in prescribing decision, and that specializations with higher use of treatment (nephrologists) were more responsive to new evidence of unsafety and ineffectiveness.",
keywords = "De-adoption, Medical safety, Medication utilization, Physician prescribing",
author = "Khoa Vu and Jiani Zhou and Alexander Everhart and Nihar Desai and Jeph Herrin and Jena, {Anupam B.} and Ross, {Joseph S.} and Shah, {Nilay D.} and Pinar Karaca-Mandic",
note = "Funding Information: Analyses were supported by funding from the National Heart, Lung, and Blood Institute (R56 HL130496, PI Karaca-Mandic) the Agency for Healthcare Research and Quality (R01 HS025164, PI Karaca-Mandic), and National Institute on Aging (P01AG005842, PI of pilot grant Karaca-Mandic). These funding sources had no role in the design and conduct of the study, analysis or interpretation of the data; and preparation or final approval of the manuscript prior to publication. Funding Information: In the past 36 months, Alexander Everhart has worked as a graduate research fellow at Medtronic plc. Nihar Desai reports grants and personal fees from Amgen, grants and personal fees from Boehringer Ingelheim, grants and personal fees from Cytokinetics, personal fees from Novartis, grants and personal fees from Relypsa, and personal fees from SC Pharmaceuticals. Jeph Herrin reports grants from the Agency for Healthcare Research and Quality. Anupam Jena reports grants from the National Institutes of Health, personal fees from Pfizer, personal fees from Hill Rom Services, Inc., personal fees from Bristol Myers Squibb, personal fees from Novartis Pharmaceuticals, personal fees from Vertex Pharmaceuticals, personal fees from Precision Health Economics, personal fees from Amgen, personal fees from Eli Lilly, personal fees from Analysis Group, personal fees from Sanofi Aventis, personal fees from Celgene, personal fees from Tesaro, personal fees from AstraZeneca, and personal fees from Biogen. Joseph Ross reports grants from the Food and Drug Administration, grants from Medtronic plc, grants from Johnson & Johnson, grants from the Centers for Medicare and Medicaid Services, grants from Blue Cross-Blue Shield Association, grants from the Agency for Healthcare Research and Quality, grants from Laura and John Arnold Foundation, grants from the National Institutes of Health - National Heart Lung, and Blood Institute, grants from the Laura and John Arnold Foundation, and grants from the Medical Devices Innovation Consortium. Dr. Shah has received research support through Mayo Clinic from the Food and Drug Administration, the Centers of Medicare and Medicaid Services, Agency for Healthcare Research and Quality, National Science Foundation, and PCORI. Dr. Karaca Mandic reports grants from the Agency for Healthcare Research and Quality, grants from the National Institutes of Health - National Heart, Lung, and Blood Institute, grants from the American Cancer Society, personal fees from Tactile Medical, Precision Health Economics and Sempre Health for work unrelated to this project. Publisher Copyright: {\textcopyright} 2021, The Author(s).",
year = "2021",
month = dec,
doi = "10.1186/s12882-021-02491-y",
language = "English (US)",
volume = "22",
journal = "BMC Nephrology",
issn = "1471-2369",
publisher = "BioMed Central",
number = "1",
}