National Trends in Active Surveillance for Prostate Cancer: Validation of Medicare Claims-based Algorithms

To better describe the real-world use of active surveillance. Active surveillance is a preferred management option for low-risk prostate cancer, yet its use outside of high-volume institutions is poorly understood. We created multiple claims-based algorithms, validated them using a robust clinical registry, and applied them to Medicare claims to describe national utilization.

We identified men with prostate cancer from 2012-2014 in a 100% sample of Michigan Medicare data and linked them with the Michigan Urologic Surgery Improvement Collaborative (MUSIC) registry. Using MUSIC treatment assignment as the standard, we determined the performance of 8 claims-based algorithms to identify men on active surveillance. We selected 3 algorithms (the most sensitive, the most specific, and a balanced algorithm incorporating age and comorbidity) and applied them to a 20% national Medicare sample to describe national trends.

We identified 1186 men with incident prostate cancer and completely linked data. Eight algorithms were tested with sensitivity ranging from 23.5% to 88.2% and specificity ranging from 93.5% to 99.1%. We found that the use of surveillance for men with incident prostate cancer increased from 2007 to 2014, nationally. However, among all men in the population, there was a large decrease in the rate of prostate cancer diagnosis and an increased or stable rate in the use of active surveillance, depending on the algorithm used. Less than 25% of men on active surveillance underwent a confirmatory prostate biopsy.

We describe the performance of claims-based algorithms to identify active surveillance.

Urology. 2018 Jul 07 [Epub ahead of print]

Parth K Modi, Samuel R Kaufman, Ji Qi, Brian R Lane, Michael L Cher, David C Miller, Brent K Hollenbeck, Vahakn B Shahinian, James M Dupree

Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI. Electronic address: ., Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI. Electronic address: ., Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI. Electronic address: ., Urologic Oncology, Spectrum Health, Grand Rapids, MI. Electronic address: ., Department of Urology, Wayne State University, Detroit, MI. Electronic address: ., Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI. Electronic address: ., Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI. Electronic address: ., Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI. Electronic address: ., Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI. Electronic address: .