SUO 2017: Effect of Radiation Facility Ownership on Variation in Prostate Cancer Treatment and Spending

Washington, DC ( Differences in prostate cancer treatment arise from multiple patient and disease factors, as well as financial incentives from radiation facility ownership. These factors may serve as additional sources of variation. Dr. Tudor Borza and colleagues presented findings from their study assessing the effect of radiation facility ownership on variation in prostate cancer treatment and spending at the 18th Annual Meeting of the Society of Urologic Oncology.

The authors utilized a 20% Medicare sample to perform a retrospective cohort study of men with newly diagnosed prostate cancer between 2010 and 2013. Urologists were categorized by their practice affiliation (single specialty vs. multispecialty group) and ownership of a radiation facility. For single specialty groups, generalized estimating equations adjusting for patient variables were used to calculate rates of treatment within one year of diagnosis, potential overtreatment (i.e. treatment in patients with a 10-year risk of non-cancer mortality exceeding 75%) and annual price standardized per-beneficiary spending. Overall, there were 19,063 men who were cared for by urologists affiliated with one of 561 single specialty groups, 88 of which were radiation facility owners. The mean rate of initial treatment was 70% with wide variation noted among groups (range 47%-87%). The mean rate of potential overtreatment was 44% (range 15%-80%) and mean annual spending was $20,668 (range $12,865-$34,964). Only 16% of radiation facility owning groups had initial treatment rates below the mean while 57% were in the highest quartile with similar trends noted in potential overtreatment. For annual spending, only 11% of radiation facility owning groups were below the mean and 68% were in the highest quartile. 

Dr. Borza concluded that there was a wide variation in rates of treatment and spending among single specialty urology groups. The majority of groups with radiation facility ownership had high rates of initial treatment, potential overtreatment, and annual spending in the highest quartile. Radiation facility ownership appears to play a role in how patients with newly diagnosed prostate cancer are treated and how resources are allocated.

Presented by: Tudor Borza, MD, MS¹

Co-Authors: Phylis Yan MS¹, Samuel R Kaufman MS¹, Lindsey A Herrel MD, MS¹, Ted A Skolarus MD, MPH², Vahakn B Shahinian MD, MS³ and Brent K Hollenbeck MS, MS¹
Affiliation: ¹University of Michigan Department of Urology, Ann Arbor, MI; ²University of Michigan Department of Urology, Ann Arbor, MI, VA Ann Arbor Healthcare System, Center for Clinical Management and Research; ³Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan

Written by: Zachary Klaassen, MD, Society of Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre @zklaassen_md at the 18th Annual Meeting of the Society of Urologic Oncology, November 20-December 1, 2017 – Washington, DC

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