Observational studyAnnals of internal medicine2014
Geographic variation in cancer-related imaging: Veterans Affairs health care system versus Medicare.
Observational study in Annals of internal medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Cost of Low-Value Imaging Worldwide: A Systematic Review.Applied health economics and health policy · 2024Pooled it
- Determinants of the overuse of imaging in low-risk prostate cancer: A systematic review.Urologic oncology · 2017Pooled it
- FDG PET/CT in cancer: comparison of actual use with literature-based recommendations.European journal of nuclear medicine and molecular imaging · 2016Pooled it
- Practice-Level Spending Variation for Radiation Treatment Episodes Among Older Adults With Cancer.JAMA health forum · 2025Article
- Summary of Veterans Health Administration Cancer Data Sources.Journal of registry management · 2024Article
- Variation in Low-Value Service Use Across Veterans Affairs Facilities.Journal of general internal medicine · 2023Article
- Geographical variations in the use of outpatient diagnostic imaging in Norway 2019.Acta radiologica open · 2022Article
- End-of-Life Cost Trajectories in Cancer Patients Treated by Medicare versus the Veterans Health Administration.Journal of the American Geriatrics Society · 2021Article
- A Medicaid Alternative Payment Model Program In Oregon Led To Reduced Volume Of Imaging Services.Health affairs (Project Hope) · 2020Article
- Reliance on Medicare Providers by Veterans after Becoming Age-Eligible for Medicare is Associated with the Use of More Outpatient Services.Health services research · 2018Article
- Regional Variations: The Use Of Hospitals, Home Health, And Skilled Nursing In Traditional Medicare And Medicare Advantage.Health affairs (Project Hope) · 2018Article
- Geographic Variation in Cardiac Rehabilitation Participation in Medicare and Veterans Affairs Populations: Opportunity for Improvement.Circulation · 2018Article
- Payer Type and Low-Value Care: Comparing Choosing Wisely Services across Commercial and Medicare Populations.Health services research · 2018Article
- Relation Between Narrow Networks and Providers of Cancer Care.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2017Article
- Geographic Variations and Time Trends in Cancer Treatments in Taiwan.BMC public health · 2017Observational
- Cancer Incidence Among Patients of the U.S. Veterans Affairs Health Care System: 2010 Update.Military medicine · 2017Article
- A Practical Framework for Understanding and Reducing Medical Overuse: Conceptualizing Overuse Through the Patient-Clinician Interaction.Journal of hospital medicine · 2017Review
- Cardiac Stress Test Trends Among US Patients Younger Than 65 Years, 2005-2012.JAMA cardiology · 2016Article
- Exploring Big Data in Hematological Malignancies: Challenges and Opportunities.Current hematologic malignancy reports · 2016Review
- Use of Positron Emission Tomography to Detect Recurrence and Associations With Survival in Patients With Lung and Esophageal Cancers.Journal of the National Cancer Institute · 2016Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundGeographic variations in use of medical services have been interpreted as indirect evidence of wasteful care. Less overuse of services, however, may not be reliably associated with less geographic variation.
objectiveTo compare average use and geographic variation in use of cancer-related imaging between fee-for-service Medicare and the Department of Veterans Affairs (VA) health care system.
designObservational analysis of cancer-related imaging from 2003 to 2005 using Medicare and VA utilization data linked to cancer registry data. Multilevel models, adjusted for sociodemographic and tumor characteristics, were used to estimate mean differences in annual imaging use between cohorts of Medicare and VA patients within geographic areas and variation in use across areas for each cohort.
setting40 hospital referral regions. PATIENTS: Older men with lung, colorectal, or prostate cancer, including 34,475 traditional Medicare beneficiaries (Medicare cohort) and 6835 VA patients (VA cohort). MEASUREMENTS: Per-patient count of imaging studies for which lung, colorectal, or prostate cancer was the primary diagnosis (each study weighted by a standardized price), and a direct measure of overuse-advanced imaging for prostate cancer at low risk for metastasis.
resultsAdjusted annual use of cancer-related imaging was lower in the VA cohort than in the Medicare cohort (price-weighted count, $197 vs. $379 per patient; P < 0.001), as was annual use of advanced imaging for prostate cancer at low risk for metastasis ($41 vs. $117 per patient; P < 0.001). Geographic variation in cancer-related imaging use was similar in magnitude in the VA and Medicare cohorts. LIMITATION: Observational study design.
conclusionUse of cancer-related imaging was lower in the VA health care system than in fee-for-service Medicare, but lower use was not associated with less geographic variation. Geographic variation in service use may not be a reliable indicator of the extent of overuse. PRIMARY FUNDING SOURCE: Doris Duke Charitable Foundation and Department of Veterans Affairs Office of Policy and Planning.
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