Publications

2009
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. Website Abstract

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. Website Abstract

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. Website 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.

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.
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Cutler, David M, Edward L Glaeser, and Jacob Vigdor. 2008. “When Are Ghettos Bad? Lessons from Immigrant Segregation In the United States.” Journal of Urban Economics 63 (3): 759-774. Website
Cutler, David M, Ellen Meara, and Seth Richards. 2008. “The Gap Gets Bigger: Changes in Mortality and Life Expectancy by Education, 1981-2000.” Health Affairs 27 (2): 350-360. Website
Cutler, David M, Edward L Glaeser, and Jacob Vigdor. 2008. “Is the Melting Pot Still Hot? Explaining the Resurgence of Immigrant Segregation.” Review of Economics and Statistics 90 (3): 478-497. Website
Cutler, David M, Sara Bleich, Christopher Murray, and Alyce Adams. 2008. “Why Is The Developed World Obese?” Annual Review of Public Health 29: 273-295 . Website
Cutler, David M. 2008. “Medical Care, US Style: A Little of Everything.” Understanding America: The Anatomy of an Exceptional Nation, edited by Peter Shuck James HQ and Wilson. New York: Public Affairs. Website
Cutler, David M, Ken Langa, Eric Larson, Jason Karlawish, Mohammed Kabeto, Scott Kim, and Allison B Rosen. 2008. “Trends in the Prevalence and Mortality of Cognitive Impairment in the United States: Is There Evidence of a Compression of Cognitive Morbidity?” Alzheimers and Dementia 4 (2): 134-144. Website
Cutler, David M, Joseph Lapado, Udo Hoffman, Fabian Bamberg, John T Nagurney, Milt Weinstein, and Scott Gazelle. 2008. “Cost Effectiveness of Coronary MDCT in the Triage of Patients with Acute Chest Pain.” American Journal of Roentgenology 191 (2): 455-463 . Website
Cutler, David M, Allison B Rosen, Susan T Stewart, and Rebecca M Woodward. 2008. “The Impact of Symptoms and Impairments on Overall Health in US National Health Data.” Medical Care 46 (9): 954-962. Website
Cutler, David M. 2008. “Health Care in the Next Administration.” New England Journal of Medicine 359 (15). Website
Cutler, David M. 2008. “Are We Finally Winning the War on Cancer?” Journal of Economic Perspectives 22 (4): 3-26. Website
Cutler, David M, Bradford J Delong, and Ann Marie Marciarille. 2008. “Why Obama's Health Plan is Better.” Wall Street Journal, sec. Opinion. Website
2007
Cutler, David M, Sara Bleich, Alyce Adams, Rafael Lozano, and Christopher Murray. 2007. “Impact of Insurance and Supply of Health Professionals on Coverage of Treatment of Hypertension: Evidence from Mexico.” British Medical Journal 335: 875-878. Website

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