In this study, the authors evaluate the SEER-Medicare data (which is limited by its nature to patients > 65 years old) between 2004 to 2011; they identified nearly 37,000 patients with bladder cancer in that time frame. Using that patient cohort, they attempted to identify predictors of receipt of each of the imaging modalities and trends in utilization. They limited it to modalities utilized within 12 months of diagnosis. They further went on to assess cost of each of these modalities using Medicare reimbursements.
In Table 1, which had a lot of information in it, they provided baseline characteristics of all the patients based on imaging type. However, on further evaluation, it actually represented either a univariate or multivariable analysis predicting receipt of each therapy. It is also unclear how they decided which demographic variables to include in the analysis. However, based on this, they state that the receipt of PET/CT was higher in younger, female, non-hispanic white, married patients in the South and West of the US. It was also more common in patients with higher grade tumors, advanced stage disease, hydronephrosis present, or those who received RC+chemotherapy. However, the specific odds ratios are not detailed.
Figure 1 highlighted the changing utilization of each of the modalities over that 8 year period, stratified by stage. PET/CT utilization has been increasing, primarily for stage 2-4 disease. It is approximately 25-30% in stage 4 patients. Utilization of MRI decreased during that same time frame, across all stages. As expect, utilization of CT scan remains high >95% throughout, for stages 2-4; for stage 1, it was utilized approximately 70% of the time.
Overall, though, only 3.5% of the entire population received a PET/CT, while 4.1% received MRI. 58.2% received CT across the entire cohort. This translated to a national excess cost of $11.6 million.
There are significant flaws with the study, but it highlights an important point – physicians have been too eager to jump into a novel technology without appropriate evidence.
The authors appropriately note that despite the rapid uptake of PET/CT technology, without any good data regarding its utility, the cost to the system may be unwarranted. Further evaluation of the role of PET/CT should be carefully analyzed.
Presented by: Christopher Kosarek
Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, Twitter: @tchandra_uromd at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal