Diffusion of Drug-Eluting Stents in PTCA Procedures

Advances in medical technology are an important contributor to improvements in health care, but the diffusion of new procedures and technologies among physicians has not been widely studied. In this paper we study the physician-level diffusion of a new technology for coronary heart disease in Pennsylvania: the use of drug-eluting stents in percutaneous transluminal coronary angioplasty (PTCA) procedures. We examine whether adoption of drug-eluting stents by physicians is affected by competition among physicians and by Health Maintenance Organization (HMO) penetration, controlling for the characteristics of physicians, patients, and hospitals during the period 2003-2008. Our data on patients’ and hospitals’ characteristics are from the Pennsylvania Health Care Cost Containment Council (PHC4) and the American Hospital Association (AHA), and we collected data on physicians’ characteristics from publicly available websites. We find that competition hastened both diffusion of DES from 2003-2006, when physicians were quickly adopting the new technology, and abandonment of DES after 2006, when new information came out revealing problems with the new stents. We also find that HMO penetration is not significantly associated with DES diffusion from 2003-2006, but positively and significantly related to the diffusion of DES from 2006-2008. Finally, we find that the effect competition among physicians differs, depending on the degree of HMO penetration.