Publications

2010
Cutler, David M. 2010. “Health Reform Passes the Cost Test.” Wall Street Journal.
2009
Cutler, David M, Murray Aitken, and Ernst Berndt. 2009. “Prescription Drug Spending Trends in the United States: Looking Beyond the Turning Point.” Health Affairs 28 (1): 151-160. Publisher's Version
Cutler, David M, Edward L Glaeser, and Allison B Rosen. 2009. “Is The U.S. Population Behaving Healthier?.” Social Security Policy in a Changing Environment, edited by Jeffrey Liebman and David M Cutler. Publisher's Version
Cutler, David M, Mary Beth Landrum, and Kate Stewart. 2009. “Intensive Medical Care and Cardiovascular Disease Disability Reductions.” Health at Older Ages: The Causes and Consequences of Declining Disability Among the Elderly, edited by David M Cutler and David Wise. Chicago: University of Chicago Press. Publisher's Version
Cutler, David M, Mary Beth Landrum, and Kate Stewart. 2009. “Clinical Pathways to Disability.” Health at Older Ages: The Causes and Consequences of Declining Disability Among the Elderly, edited by David Cutler and David Wise. Chicago: University of Chicago Press. Publisher's Version
Cutler, David M, Mary Beth Landrum, and Kate Stewart. 2009. “How Do The Better Educated Do It? Socioeconomic Status and Ability to Cope with Underlying Impairment.” Developments in the Economics of Aging, edited by David Wise. Chicago: University of Chicago Press. Publisher's Version
Cutler, David M, and Edward L Glaeser. 2009. “Why Do Europeans Smoke More Than Americans?.” Developments in the Economics of Aging, edited by David Wise. Chicago: University of Chicago Press. Publisher's Version
Cutler, David M, and Allison B Rosen. 2009. “Challenges in Building Disease-Based National Health Accounts.” Medical Care 47 (7): S7-S13. Publisher's Version
Cutler, David M, and Alex Gelber. 2009. “Changes in the Incidence and Duration of Periods Without Insurance.” New England Journal of Medicine 360 (17): 1740-1748. Publisher's Version
Cutler, David M. 2009. “The Next Wave of Corporate Medicine -- How We All Might Benefit.” New England Journal of Medicine 361 (6): 549-551. Website
Cutler, David M, Dana P Goldman, Yuhui Zheng, Federico Girosi, Pierre-Carl Michaud, and Jay S Olshansky. 2009. “The Benefits of Risk Factor Prevention in Americans Aged 51 and Older.” American Journal of Public Health 99 (11): 2096-2101. Website
Brauer, Carmen, Marcelo Coca-Parraillon, David M Cutler, and Allison B Rosen. 2009. “Incidence and Mortality of Hip Fractures in the United States.” JAMA 302 (14): 1573-1579. WebsiteAbstract

Context Understanding the incidence and subsequent mortality following hip fracture is essential to measuring population health and the value of improvements in health care.

Objective To examine trends in hip fracture incidence and resulting mortality over 20 years in the US Medicare population.

Design, Setting, and Patients Observational study using data from a 20% sample of Medicare claims from 1985-2005. In patients 65 years or older, we identified 786 717 hip fractures for analysis. Medication data were obtained from 109 805 respondents to the Medicare Current Beneficiary Survey between 1992 and 2005.

Main Outcome Measures Age- and sex-specific incidence of hip fracture and age- and risk-adjusted mortality rates.

Results Between 1986 and 2005, the annual mean number of hip fractures was 957.3 per 100 000 (95% confidence interval [CI], 921.7-992.9) for women and 414.4 per 100 000 (95% CI, 401.6-427.3) for men. The age-adjusted incidence of hip fracture increased from 1986 to 1995 and then steadily declined from 1995 to 2005. In women, incidence increased 9.0%, from 964.2 per 100 000 (95% CI, 958.3-970.1) in 1986 to 1050.9 (95% CI, 1045.2-1056.7) in 1995, with a subsequent decline of 24.5% to 793.5 (95% CI, 788.7-798.3) in 2005. In men, the increase in incidence from 1986 to 1995 was 16.4%, from 392.4 (95% CI, 387.8-397.0) to 456.6 (95% CI, 452.0-461.3), and the subsequent decrease to 2005 was 19.2%, to 369.0 (95% CI, 365.1-372.8). Age- and risk-adjusted mortality in women declined by 11.9%, 14.9%, and 8.8% for 30-, 180-, and 360-day mortality, respectively. For men, age- and risk-adjusted mortality decreased by 21.8%, 25.4%, and 20.0% for 30-, 180-, and 360-day mortality, respectively. Over time, patients with hip fracture have had an increase in all comorbidities recorded except paralysis. The incidence decrease is coincident with increased use of bisphosphonates.

Conclusion In the United States, hip fracture rates and subsequent mortality among persons 65 years and older are declining, and comorbidities among patients with hip fractures have increased.

Stewart, Susan T, David M Cutler, and Allison B Rosen. 2009. “Forecasting the Effects of Obesity and Smoking on U.S. Life Expectancy.” New England Journal of Medicine 361: 2252-2260. Website
Lapado, Joseph, Farouc Jaffer, Udo Hoffmann, Carey Thomson, David M Cutler, Fabian Bamberg, William Dec, Milt Weinstein, and Scott Gazelle. 2009. “Clinical Outcomes and Cost-Effectiveness of Coronary Computed Tomography Angiography in the Evaluation of Patients with Chest Pain.” Journal of the American College of Cardiology 54 (25): 2409-2422. WebsiteAbstract

OBJECTIVES: The aim of this study was to project clinical outcomes, health care costs, and cost-effectiveness of coronary computed tomography angiography (CCTA), as compared with conventional diagnostic technologies, in the evaluation of patients with stable chest pain and suspected coronary artery disease (CAD).

BACKGROUND: CCTA has recently been found to be effective in the evaluation of patients with suspected CAD, but investigators have raised concerns related to radiation exposure, incidental findings, and nondiagnostic exams.

METHODS: With published data, we developed a computer simulation model to project clinical outcomes, health care costs, and cost-effectiveness of CCTA, compared with conventional testing modalities, in the diagnosis of CAD. Our target population included 55-year-old patients who present to their primary care physicians with stable chest pain.

RESULTS: All diagnostic strategies yielded similar health outcomes, but performing CCTA-with or without stress testing or performing stress single-photon emission computed tomography-marginally minimized adverse events and maximized longevity and quality-adjusted life-years (QALYs). Health outcomes associated with these strategies were comparable, with CCTA in men and women yielding the greatest QALYs but only by modest margins. Overall differences were small, and performing the most effective test-compared with the least effective-decreased adverse event rates by 3% in men and women. Comparable increases in longevity and QALYs were 2 months and 0.1 QALYs in men and 1 month and 0.03 QALYs in women. CCTA raised overall costs, partly through the follow-up of incidental findings, and when performed with stress testing, its incremental cost-effectiveness ratio ranged from $26,200/QALY in men to $35,000/QALY in women. Health outcomes were marginally less favorable in women when radiation risks were considered.

CONCLUSIONS: CCTA is comparable to other diagnostic studies and might hold good clinical value, but large randomized controlled trials are needed to guide policy.

Lapado, Joseph, Jill R Horwitz, Milt Weinstein, and David M Cutler. 2009. “Adoption and Spread of New Imaging Technology: A Case Study.” Health Affairs 28 (6): 1122-1132. WebsiteAbstract

Technology is a major driver of health care costs. Hospitals are rapidly acquiring one new technology in particular: 64-slice computed tomography (CT), which can be used to image coronary arteries in search of blockages. We propose that it is more likely to be adopted by hospitals that treat cardiac patients, function in competitive markets, are reimbursed for the procedure, and have favorable operating margins. We find that early adoption is related to cardiac patient volume but also to operating margins. The paucity of evidence informing this technology's role in cardiac care suggests that its adoption by cardiac-oriented hospitals is premature. Further, adoption motivated by operating margins reinforces concerns about haphazard technology acquisition.

Cutler, David M, Karen Davis, and Kristof Stremikis. 2009. Why Health Reform Will Bend the Cost Curve. Commonwealth Fund Issue Brief. WebsiteAbstract

The health reform bills passed by the U.S. House of Representatives and under consideration in the Senate introduce a range of payment and delivery system changes designed to achieve a significant slowing of health care cost growth. Most assessments of health reform legislation have focused only on the federal budgetary impact. This study projects the effect of national reform on total national health expenditures and the insurance premiums that American families would likely pay. We estimate that the combination of provisions in the House and Senate bills would save $683 billion or more in national health spending over the 10-year period 2010–2019 and lower premiums by nearly $2,000 per family. Moreover, the annual growth rate in national health expenditures could be slowed from 6.4 percent to 6.0 percent.

Health at Older Ages: The Causes and Consequences of Declining Disability Among the Elderly
Cutler, David M, and David Wise. 2009. Health at Older Ages: The Causes and Consequences of Declining Disability Among the Elderly. Chicago: University of Chicago Press. Website
Cutler, David M, Karen Davis, and Kristof Stremikis. 2009. Why Health Reform Will Bend the Cost Curve. Center for American Progress and The Commonwealth Fund.Abstract

The health reform bills passed by the U.S. House of Representatives and under consideration in the Senate introduce a range of payment and delivery system changes designed to achieve a significant slowing of health care cost growth. Most assessments of health reform legislation have focused only on the federal budgetary impact. This study projects the effect of national reform on total national health expenditures and the insurance premiums that American families would likely pay. We estimate that the combination of provisions in the House and Senate bills would save $683 billion or more in national health spending over the 10-year period 2010–2019 and lower premiums by nearly $2,000 per family. Moreover, the annual growth rate in national health expenditures could be slowed from 6.4 percent to 6.0 percent.

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2008
Cutler, David, and Adriana Lleras-Muney. 2008. “Education and Health: Evaluating Theories and Evidence.” Making Americans Healthier: Social and Economic Policy as HealthPolicy, edited by J House, R Schoeni, G Kaplan, and H Pollack. New York: Russell Sage Foundation. Website
Cutler, David, Amy Finkelstein, and Kathleen McGarry. 2008. “Preference Heterogeneity and Insurance Markets: Explaining a Puzzle of Insurance.” American Economic Review. PDF

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