Treatment trends and Medicare reimbursements for localized prostate cancer in elderly patients

  • Paolo Dell'Oglio Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
  • Anne Sophie Valiquette Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, University of Montreal Health Center, Montreal, Canada.
  • Sami-Ramzi Leyh-Bannurah Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Martini-Clinic, prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
  • Zhe Tian Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
  • Vincent Trudeau Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, University of Montreal Health Center, Montreal, Canada.
  • Alessandro Larcher Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Shahrokh F. Shariat Department of Urology, Medical University of Vienna and General Hospital, Vienna, Austria.
  • Umberto Capitanio Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Alberto Briganti Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Markus Graefen Martini-Clinic, prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
  • Francesco Montorsi Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Pierre I. Karakiewicz Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, University of Montreal Health Center, Montreal, Canada.

Abstract

Introduction: The absolute and proportional numbers of elderly patients diagnosed with localized prostate cancer (PCa) are on the rise. We examined treatment trends and reimbursement figures in localized PCa patients aged ≥80 years.

Methods: Between 2000 and 2008, we identified 30 217 localized PCa patients aged ≥80 years in Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database. Alternative treatment modalities consisted of conservative management (CM), radiation therapy (RT), radical prostatectomy (RP), and primary androgendeprivation therapy (PADT). For all four modalities, utilization and reimbursements were examined.

Results: PADT was the most frequently used treatment modality between 2000 and 2005. CM became the dominant treatment modality from 2006‒2008. RP rates were marginal. RT ranked third, and its annual rate increased from 20.77% in 2000 to 29.13% in 2008. Median individual reimbursement of RT was highest and ranged from $29 343 in 2000 to $31 090 in 2008, followed by RP (from $20 560 in 2000 to $19 580 in 2008), PADT (from $18 901 in 2000 to $8000 in 2008), and CM (from $1824 in 2000 to $1938 in 2008). RT contributed to most of the cumulative annual reimbursements from 2003 (49.24%) to 2008 (72.97%). PADT ranked first from 2000 (54.56%) to 2002 (50.49%), but decreased by 19.40% in 2008. CM’s contribution increased from 4.42% in 2000 to 6.96% in 2008. RP’s share of reimbursements was stable during the study period.

Conclusions: Our results, focusing on localized PCa treatment in patients aged ≥80 years, showed an important increase in rates, median cost, and proportion of cumulative cost related to RT.

Published
2018-03-15
How to Cite
Dell’Oglio, P., Valiquette, A. S., Leyh-Bannurah, S.-R., Tian, Z., Trudeau, V., Larcher, A., Shariat, S., Capitanio, U., Briganti, A., Graefen, M., Montorsi, F., & Karakiewicz, P. (2018). Treatment trends and Medicare reimbursements for localized prostate cancer in elderly patients. Canadian Urological Association Journal, 12(7), E338-44. https://doi.org/10.5489/cuaj.4865
Section
Original Research