These Two Factors Play A Significant Role in Driving Unnecessary Overspending in Prostate Cancer Patients

Despite having similar disease and demographic profiles, prostate cancer patients vary significantly in terms of spending, according to a new study. Two significant drivers of costs for prostate cancer patients, the authors found, are physicians and facilities.

“Prostate cancer is the most common male cancer, with a wide range of treatment options. Payment reform to reduce unnecessary spending variation is an important strategy for reducing waste, but its magnitude and drivers within prostate cancer are unknown,” the researchers posited.

The study authors assessed localized prostate cancer patients aged 66 years and older who were enrolled in Medicare fee‐for‐service and were included in the Surveillance, Epidemiology, and End Results‐Medicare database from 2009 to 2014. They employed multilevel linear regression with physician and facility random effects to determine how urologists, radiation oncologists, and their facilities affected differences in overall patient spending in the one year following diagnosis. Factors taken into consideration for their effects on spending variation included patient characteristics, disease risk, and treatments. Physicians and facilities were stratified into quintiles based on adjusted patient-level spending; high- and low-spending between-group comparisons were made.

The researchers observed a significant effect on spending influenced by physician and facility factors. Differing cancer treatment modalities played a more significant role in cost variation compared to differences in patient and disease characteristics (urologists, 72% vs. 2%; radiation oncologists, 20% vs. 18%).

“The highest spending physicians spent 46% more than the lowest and had more imaging tests, inpatient care, and radiotherapy spending. There were no differences across spending quintiles in the use of robotic surgery by urologists or the use of brachytherapy by radiation oncologists,” the researchers further noted.

The study was published in the journal Cancer.

Prostate Cancer: Different Effects for Different Treatments

Prostate cancer is the most common cancer in men, so knowledge of factors that drive costs as well as the effects of different treatments is critical. Recently, a different study examined functional outcomes over five years correlated with five different treatments for localized prostate cancer.

This study included data from 2,005 patients (median [interquartile range] age, 64 [59-70] years; 1,993 [77%] were non-Hispanic white). Nerve-sparing prostatectomy, compared to active surveillance, resulted in poorer five-year urinary incontinence (adjusted mean difference, –10.9; 95% confidence interval [CI], –14.2 to –7.9) and three-year sexual function (adjusted mean difference, –15.2; 95% CI, –18.8 to –11.5). Low-dose-rate brachytherapy, compared to active surveillance, was predictive of worse one-year urinary irritative (adjusted mean difference, –7.0; 95% CI, –10.1 to –3.9), sexual (adjusted mean difference, –10.1; 95% CI, –14.6 to –5.7), and bowel (adjusted mean difference, –5.0; 95% CI, –7.6 to –2.4) function. External beam radiation therapy (EBRT) in favorable-disease men did not largely differ from active surveillance at any point in the study in terms of urinary, sexual, and bowel function changes.

In the unfavorable-risk disease group, EBRT with androgen deprivation therapy, compared to prostatectomy, resulted in worse six-month hormonal function (adjusted mean difference, –5.3; 95% CI, –8.2 to –2.4) and one-year bowel function (adjusted mean difference, –4.1; 95% CI, –6.3 to –1.9), but better five-year sexual function (adjusted mean difference, 12.5; 95% CI, 6.2–18.7) and incontinence at every time point over the five-year study period (adjusted mean difference, 23.2; 95% CI, 17.7–28.7).