Dissertation Title："Adoption of New Medical Technologies: The Case of Cervical Cancer Prevention"

New medical technologies have the potential to improve health outcomes substantially and cost-effectively, if used appropriately. This dissertation uses the context of cervical cancer prevention to investigate factors associated with adoption of new medical technologies and to assess their effects on health outcomes.

Paper one is a longitudinal analysis of the factors associated with adoption of the human papillomavirus (HPV) DNA test for cervical cancer screening in a Medicaid population. Although Black and Hispanic women were initially less likely than White women to receive HPV DNA tests, disparities resolved within the test’s initial five years on the market. Obstetricians/gynecologists were more likely to use the tests than were primary care providers. These results suggest that uptake of new medical technologies can occur quickly among underserved groups, and may be bolstered by early adoption by specialists.

Paper two is a difference-in-differences analysis of the effects of clinical guidelines and a targeted direct-to-consumer (DTC) advertising campaign on overall and appropriate use of HPV DNA tests among privately insured women nationwide. DTC advertising was associated with increases in overall use of the HPV DNA test, while clinical guidelines were differentially associated with appropriate use. These findings suggest the potential for complementary applications of consumer marketing and professional guidelines to promote appropriate use of underutilized medical technologies.

Paper three simulates the effects of cervical cancer prevention policies on health outcomes in the overall population, as well as among Black and Hispanic women, who are at higher risk of cervical cancer. Several strategies, including more widespread use of screening and school-entry mandates for HPV vaccines, have the potential to reduce incidence and mortality from cervical cancer in the US substantially. Screening policies stand to benefit Hispanic women more than vaccine promotion policies. Continued differential uptake of the HPV vaccine across race and ethnic groups may result in a widening of disparities in cervical cancer outcomes between White and minority women. These findings highlight the importance of considering subgroup differences when assessing the potential effects of new medical technologies on health outcomes.