Skip to main content
main-content

01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Urology 1/2015

Reimbursement cuts and changes in urologist use of androgen deprivation therapy for prostate cancer

Zeitschrift:
BMC Urology > Ausgabe 1/2015
Autoren:
Vahakn B Shahinian, Yong-Fang Kuo
Wichtige Hinweise

Competing interests

VBS is a paid consultant to Amgen, Inc.

Authors’ contributions

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.

Abstract

Background

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.

Methods

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).

Results

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.

Conclusion

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.
Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 1/2015

BMC Urology 1/2015 Zur Ausgabe

Neu im Fachgebiet Urologie

Meistgelesene Bücher in der Urologie

2016 | Buch

Anogenitale Hautkrankheiten

Erkennen, Befunden, Behandeln

Hautkrankheiten im Bereich Genitale werden werden oft erstmals von einem Facharzt beobachtet, der sich mit anderen genitalen Beschwerden beschäftigt – der Urologe bei Männern oder der Gynäkologe bei Frauen. Dieses Buch schult den Blick für anogenitale Dermatosen und gibt Tipps zur Therapie.

Herausgeber:
Walter Krause, Isaak Effendy

2015 | Buch

Inkontinenz- und Deszensuschirurgie der Frau

Harninkontinenz ist eines der häufigsten Symptome in der Urologie und Gynäkologie. OP-Atlas, unverzichtbarer Ratgeber, kompaktes Nachschlagewerk in einem: Mithilfe dieses Buches werden Sie Spezialist in Sachen Inkontinenz- und Deszensuschirurgie.

Herausgeber:
Rainer Hofmann, Uwe Wagner

Mail Icon II Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Urologie und bleiben Sie gut informiert – ganz bequem per eMail.

Bildnachweise