Abstract
Purpose
Since 2012, about 80 specialty societies have released Choosing Wisely (CW) recommendations aimed at reducing the use of low-value, unproven, or ineffective medical services. The extent to which these recommendations have influenced the behavior of physicians and patients remains largely unknown.
Methods
Using MarketScan Commercial Claims and Medicare Supplemental and Coordination of Benefits databases, we identified annual cohorts of women with incident, early-stage breast cancer and estimated the prevalence of four initial treatment and six surveillance metrics deemed as low-value breast cancer care by CW. Multivariable logistic regressions were subsequently used to estimate temporal trends and regional variation in the use of these metrics, with a special focus on the year of CW’s publication.
Results
There were 122,341 women identified as undergoing treatment for incident breast cancer between 2010 and 2014. Two of the four low-value initial treatment metrics and four of the six low-value surveillance metrics declined significantly over time. The temporal trend of declining use, however, preceded the release of CW’s guidelines. Declines ranged from 11.0% for follow-up mammography to 40.6% for receipt of surgical biopsy without an attempted needle biopsy. There were marked regional differences in use of low-value breast cancer care for all metrics, much of which persisted after publication of CW.
Conclusions
With two notable exceptions, use of low-value breast cancer care has declined steadily since 2010. The declines, however, were not accelerated by the publication of CW recommendations.
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Data availability
The datasets generated and analyzed during the current study are not publicly available given restrictions to data sharing provided to MCW under an institutional license to Truven, but further details are available from the corresponding author on reasonable request.
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Funding
The authors gratefully acknowledge the financial support from Medical College of Wisconsin (MCW) and NIH-NCI grant R01CA190016. While MCW supported this research, the institution did not have a role in the design of the study or preparation of the manuscript.
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JN: conception, design, and interpretation of the data and drafting of the article. AN: provision of study materials, critical revision for important intellectual content. TY: interpretation of the data, critical revision for important intellectual content. EM: analysis and interpretation of data, critical revision for important intellectual content. MN: analysis and interpretation of data, critical revision for important intellectual content. LP: provision of study materials, conception, design and interpretation of data, critical revision for important intellectual content.
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Per 45 CFR 46.101 and the MCW Institutional Review Board, this study did not meet criteria for human subjects research as it is a public and deidentified data set.
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Neuner, J.M., Nattinger, A.B., Yen, T. et al. Temporal trends and regional variation in the utilization of low-value breast cancer care: has the Choosing Wisely campaign made a difference?. Breast Cancer Res Treat 176, 205–215 (2019). https://doi.org/10.1007/s10549-019-05213-z
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DOI: https://doi.org/10.1007/s10549-019-05213-z