VBS is a paid consultant to Amgen, Inc.
Both authors (VBS and YK) made substantial contributions to the conception, design, analysis and interpretation of the data; VBS drafted the first draft of the manuscript and YK provided critical revision; both authors give final approval for the manuscript and agree to be accountable for all aspects of the work herein.
We examined the impact of urologist academic affiliation on use of androgen deprivation therapy (ADT) for prostate cancer before and after major reimbursement cuts for ADT in hopes of better understanding the influence of financial incentives on its use. In particular, we hypothesized that if financial incentive was the predominant factor driving use, we should see a narrowing in the previously documented gap of ADT use between non-academic and academic urologists following the reimbursement cuts.
With the Surveillance, Epidemiology and End-Results (SEER)-Medicare linked database we examined use of ADT for potentially inappropriate indications (primary therapy of localized, lower risk tumors) among patients of 2214 urologists over the period 2000–2002 and 2004–2007, representing eras before and after reimbursement cuts. Multi-level logistic regression models were used to estimate the likelihood of ADT use adjusted for patient, tumor and urologist characteristics (academic affiliation, board certification, years in practice and patient panel size).
Overall, ADT use peaked in 2002 at 46.6% of patients, but dropped dramatically in 2005, with a slow continued decrease through 2007 to 31.1%. A similar pattern was evident within most strata of urologist characteristics, including academic affiliation. In the multilevel model, patients of non-academic urologists had a 30% higher odds of receiving ADT than those of academic urologists in both the eras before and after the reimbursement cuts.
A similar proportionate drop in use of ADT among both academic and non-academic urologists following reimbursement cuts suggests that factors other than financial incentives may have played a role.
Warren J, Klabunde C, Schrag D, Bach PB, Riley GF. Overview of the SEER-medicare data: content, research applications, and generalizability to the United States elderly population. Med Care. 2002;40(suppl IV):3–18.
Baldwin L-M, Adamache E, Klabunde CN, Kenward K, Dahlman C, Warren J, et al. Linking physician characteristics and medicare claims data: issues in data availability, quality and measurement. Med Care. 2002;40(suppl IV):82–95.
McDermed J, Strum S, Scholz M. The androgen deprivation syndrome (ADS): the incidence and severity in prostate cancer (PC) patients (PTS) receiving hormone blockade (HB). Proc Am Soc Clin Oncol. 1998;17:315a.
- Reimbursement cuts and changes in urologist use of androgen deprivation therapy for prostate cancer
Vahakn B Shahinian
- BioMed Central
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