The Adoption and Diffusion of Medical Technology: Evidence From Cardiac Valve Procedures
Abstract: New health care technologies have saved millions of lives but have also been implicated in health care cost growth. The adoption of new technologies itself is a learning process, often involving physician learning and tradeoffs in quality and productivity as clinicians move from older to newer procedures. We consider the early years of uptake for a new cardiac procedure—transcatheter aortic valve replacement (TAVR)—and its implications for physician procedure mix and patient outcomes. In its first three years, TAVR grew to include over 1/3 of all aortic valve replacement procedures in New York State, which serves as the setting for our empirical analysis. Using data on all aortic valve replacement procedures performed over the period leading up to and spanning the procedure’s introduction, we document uptake across physicians and hospitals as well as patterns of access and receipt among (potential) patients. We ask whether the uptake of TAVR is correlated with prior utilization of SAVR – the more-intensive incumbent technology – at the physician and/or facility level. We find that a hospital’s pre-TAVR level of specialization in SAVR positively predicts both TAVR adoption and intensity of use. That is, hospitals that were specialized in the old procedure were more likely to take-up the new technology. We also find that surgeons’ early experience with TAVR predicts subsequent intensity of use. With respect to outcomes, we observe meaningfully shorter post-procedure length of stay in hospital following TAVR relative to SAVR, however differences in
post-procedure mortality for the the two technologies are difficult to discern. The insights from this project are relevant for a broader understanding of the impact of technology diffusion on physician treatment decisions, the accumulation of technology-specific experience by physicians, patient access to new therapies, and health care productivity.