Publications [#238728] of Frank A. Sloan

Journal Articles

1. Stein, JD; Hanrahan, BW; Comer, GM; Sloan, FA, Diffusion of technologies for the care of older adults with exudative age-related macular degeneration., American journal of ophthalmology, vol. 155 no. 4 (April, 2013), pp. 688-696.e2, ISSN 0002-9394 [doi]
   (last updated on 2024/04/24)

   Abstract:
   

   Purpose

   To determine patterns of diffusion of diagnostic tests and therapeutic interventions in the United States through 2010 for patients with newly diagnosed exudative macular degeneration (AMD).

   Design

   Retrospective longitudinal cohort analysis.

   Methods

   SETTING AND PATIENT POPULATION: A total of 23 941 Medicare beneficiaries with exudative AMD newly diagnosed during 1992-2009.

   Observation procedures

   Current Procedural Technology (CPT-4) billing codes were used to identify use of diagnostic tests (optical coherence tomography, fluorescein angiography, and fundus photography) and therapeutic interventions (argon laser photocoagulation, photodynamic therapy, intravitreal corticosteroids, and anti-vascular endothelial growth factor [VEGF] agents) used by these beneficiaries during the first year following diagnosis.

   Main outcome measures

   Rates of use of study diagnostic and therapeutic procedures.

   Results

   Diffusion was rapid for each successive new diagnostic and treatment modality, with use of newer procedures quickly replacing existing ones. The number of beneficiaries treated with anti-VEGF agents for exudative AMD was considerably greater than for prior innovations, rising from use in 4.0% of beneficiaries in 2004-05 to 62.7% in 2009-10. In each year from first diagnosis years 2006-2009 and in different practice settings, use of bevacizumab exceeded that of ranibizumab (60%-78% vs 33%-47%, respectively). Rates of diffusion of the various therapies were relatively similar in communities throughout the United States irrespective of presence of a major teaching hospital in the vicinity.

   Conclusions

   Newer, more effective therapeutic interventions for exudative AMD diffused rapidly throughout the United States, quickly replacing older, less effective interventions. Although improving patient outcomes, rapid diffusion raises important public policy issues for Medicare and other payers to consider.