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6. Improving Cardiovascular Drug and Device Development and Evidence Through Patient-Centered Research and Clinical Trials: A Call to Action From the Value in Healthcare Initiative’s Partnering With Regulators Learning Collaborative

Author

Warner, John J., Crook, Hannah L., Whelan, Karley M., Bleser, William K., Roiland, Rachel A., Hamilton Lopez, Marianne, Saunders, Robert S., Wang, Tracy Y., Hernandez, Adrian F., McClellan, Mark B., Califf, Robert M., and Brown, Nancy

Published
2020
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8. Frontiers of Upstream Stroke Prevention and Reduced Stroke Inequity Through Predicting, Preventing, and Managing Hypertension and Atrial Fibrillation: A Call to Action From the Value in Healthcare Initiative’s Predict & Prevent Learning Collaborative

Author

Bufalino, Vincent J., Bleser, William K., Singletary, Elizabeth A., Granger, Bradi B., O’Brien, Emily C., Elkind, Mitchell S. V., Hamilton Lopez, Marianne, Saunders, Robert S., McClellan, Mark B., and Brown, Nancy

Published
2020
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24. Overview of the Special Supplement Issue

Author

McClellan, Mark B. and Newhouse, Joseph P.

Abstract

Instrumental variables (IV) analysis is a technique that virtually every econometrics textbook describes and that econometricians have employed for over half a century. It is used to contrast two or [...]

Published
2000

27. The economics of medical treatment intensity

Author

James M. Poterba., Massachusetts Institute of Technology. Dept. of Economics, McClellan, Mark B, James M. Poterba., Massachusetts Institute of Technology. Dept. of Economics, and McClellan, Mark B

Abstract

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Economics, 1993., Includes bibliographical references., by Mark B. McClellan., Ph.D.

Published
2005

28. Breast Cancer: Treatment, Outcomes, and Cost-Effectiveness

Author

NATIONAL BUREAU OF ECONOMIC RESEARCH CAMBRIDGE MA, McClellan, Mark B., NATIONAL BUREAU OF ECONOMIC RESEARCH CAMBRIDGE MA, and McClellan, Mark B.

Abstract

The goal of this project was to (1) assess the validity of medical claims information for tracking breast cancer diagnoses, treatments, and outcomes; (2) use Medicare data, linked SEER cancer registry data, and claims data from large firms to analyze trends in diagnosis rates and staging, treatment, expenditures, and outcomes for Americans with breast cancer; and (3) analyze the cost effectiveness of alternative patterns of breast cancer diagnosis and treatment. The first part of Section B reviews the work done on creating cohorts of breast cancer patients and assessing the validity of the selection procedure. The second part discusses our findings on trends in breast cancer costs, treatments, and outcomes with a particular emphasis on changes in the productivity of breast cancer care. The third part reviews our work on measuring the cost effectiveness of alternative patterns of diagnosis and treatment, and introduces some innovative statistical methods we developed to help address the problem of bias. The conclusion section reviews the main findings and describes the areas for future research identified by this project.

Published
2000

29. Breast Cancer: Treatment, Outcomes, and Cost-Effectiveness

Author

NATIONAL BUREAU OF ECONOMIC RESEARCH CAMBRIDGE MA, McClellan, Mark B., NATIONAL BUREAU OF ECONOMIC RESEARCH CAMBRIDGE MA, and McClellan, Mark B.

Abstract

The goal of this project is to (1) assess the validity of medical claims information for tracking breast cancer diagnoses, treatments, and outcomes; (2) use Medicare data, linked SEER cancer registry data, and claims data from large firms to analyze trends in diagnosis rates and staging, treatment, expenditures, and outcomes for Americans with breast cancer; and (3) analyze the cost effectiveness of alternative patterns of breast cancer diagnosis and treatment. A principal cause of the limited evidence on trends and cost-effectiveness of cancer care for the elderly is the absence of precise information on the utility of medical claims databases for understanding cancer epidemiology, treatments, costs, and outcomes in large, representative population groups. To date, the project has made substantial progress in (1) constructing a set of rules for identifying cancer cases in administrative data with much higher sensitivity and specificity estimates and more accurate time of diagnosis estimates than previously reported; and (2) demonstrating the feasibility on breast cancer of an important methodological step (instrumental variables) necessary for attributing differences in outcomes to treatment differences.

Published
1998

30. Breast Cancer: Treatment, Outcomes, and Cost-Effectiveness

Author

NATIONAL BUREAU OF ECONOMIC RESEARCH CAMBRIDGE MA, McClellan, Mark B., NATIONAL BUREAU OF ECONOMIC RESEARCH CAMBRIDGE MA, and McClellan, Mark B.

Abstract

Little is known about the relationships between breast cancer treatments, costs, and outcomes across different population groups, health care delivery settings, and geographic areas. As a result of this uncertainty the cost effectiveness of different patterns of breast cancer prevention and treatment across such groups, appropriate policies for breast cancer are unclear. This research will develop evidence on these issues using a combination of very large, unique databases that integrate longitudinal information on individual treatments, costs, and outcomes and that have been linked to supplementary datasets with far more clinical detail. We will characterize variations and trends across different demographic and socioeconomic groups in all phases of breast cancer screening and treatment. We will investigate variations and trends for different measures of inpatient and outpatient costs, and different measures of patient outcomes. The resulting empirical cost-effectiveness estimates of alternative approaches to breast cancer treatment can be used to evaluate technologies used for breast cancer treatment and to guide policies affecting breast cancer management.

Published
1997

31. SCHROEDER LECTURE FDA: PROTECTING AND ADVANCING AMERICA'S HEALTH.

Author

McClellan, Mark B.

Subjects
*MEDICAL care costs, *MEDICAL care, *PUBLIC health
Abstract

Presents a speech by U.S. Food and Drug Administration commissioner Mark B. McClellan, delivered at the Case Western Reserve University's Schroeder Lecture, October 7, 2003. Concern over the increasing medical spending and access to quality care; Factors responsible for the high prices of medicines in the U.S. compared to other countries; Adverse effects of the liability system on medical care.

Published
2004

32. Practice Patterns Trends in Inpatient Treatment Intensity among Medicare Beneficiaries at the End of Life.

Author

Barnato, Amber E., Mcclellan, Mark B., Kagay, Christopher R., and Garber, Alan M.

Subjects
*MEDICARE beneficiaries, *INPATIENT care, *MEDICARE, *MEDICAL care costs, *HOSPITALS, *THERAPEUTICS
Abstract

Although an increasing fraction of Medicare beneficiaries die outside the hospital, the proportion of total Medicare expenditures attributable to care in the last year of life has not dropped. We sought to determine whether disproportionate increases in hospital treatment intensity over time among decedents are responsible for the persistent growth in end-of-life expenditures. The 1985–1999 Medicare Medical Provider Analysis and Review (MedPAR) and Denominator files. We sampled inpatient claims for 20 percent of all elderly fee-for-service Medicare decedents and 5 percent of all survivors between 1985 and 1999 and calculated age-, race-, and gender-adjusted per-capita inpatient expenditures and rates of intensive care unit (ICU) and intensive procedure use. We used the decedent-to-survivor expenditure ratio to determine whether growth rates among decedents outpaced growth relative to survivors, using the growth rate among survivors to control for secular trends in treatment intensity. The data were collected by the Centers for Medicare and Medicaid Services. Real inpatient expenditures for the Medicare fee-for-service population increased by 60 percent, from $58 billion in 1985 to $90 billion in 1999, one-quarter of which were accrued by decedents. Between 1985 and 1999 the proportion of beneficiaries with one or more intensive care unit (ICU) admission increased from 30.5 percent to 35.0 percent among decedents and from 5.0 percent to 7.1 percent among survivors; those undergoing one or more intensive procedure increased from 20.9 percent to 31.0 percent among decedents and from 5.8 percent to 8.5 percent among survivors. The majority of intensive procedures in the United States were performed in the more numerous survivors, although in 1999 50 percent of feeding tube placements, 60 percent of intubations/tracheostomies, and 75 percent of cardiopulmonary resuscitations were in decedents. The proportion of beneficiaries dying in a hospital decreased from 44.4 percent to 39.3 percent, but the likelihood of being admitted to an ICU or undergoing an intensive procedure during the terminal hospitalization increased from 38.0 percent to 39.8 percent and from 17.8 percent to 30.3 percent, respectively. One in five Medicare beneficiaries who died in the hospital in 1999 received mechanical ventilation during their terminal admission. Inpatient treatment intensity for all fee-for-service beneficiaries increased between 1985 and 1999 regardless of survivorship status. Absolute changes in per-capita hospital expenditures, ICU admissions, and intensive inpatient procedure use were much higher among decedents. Relative changes were similar except for ICU admissions, which grew faster among survivors. The secular decline in in-hospital deaths has not resulted in decreased per capita utilization of expensive inpatient services in the last year of life. This could imply that net hospital expenditures for the dying might have been even higher over this time period if the shift toward hospice had not occurred. [ABSTRACT FROM AUTHOR]

Published
2004
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