Editor's Commentary - Understanding prostate cancer spending growth among Medicare beneficiaries

BERKELEY, CA (UroToday.com) - According to a group from the University of Michigan, prostate cancer (Cap) is one of the most expensive diseases to treat, in part secondary to its chronic nature.

It outpaces spending for cancer in general at nearly $7 billion per year. In the online edition of Urology, the investigators evaluated whether the increased spending for CaP is due to the utilization of more expensive options (such as LHRH agonists instead of orchiectomy) or whether physicians are using more of all CaP services. They performed a study assessing longitudinal trends in Medicare spending among patients with CaP to measure the extent to which spending growth is a result of selective usage of higher-priced services (price) vs. greater overall usage (quantity).


The database was SEER and they evaluated patients in the fee-for-service program who were enrolled in both Parts A and B of Medicare from 12 months before diagnosis until death. They identified 111,711 patients. They evaluated the frequency and nature of CaP care and the per capita expenditures for each year of the cohort. They found that Medicare expenditures for CaP for the first 2 years after diagnosis increased by 20.2%, from $8,933 to $10,734. Per capita payments for inpatient care declined by 57% from $3,499 to $1,504, however, per capita expenditures for physician services increased by 82.8% from $3,317 to $6.062. Per capita spending for hospital outpatient care increased by 62.2% from $1,847 to $2,996. This suggests that the per capita Medicare payments for CaP appear to be increasingly dedicated to physician services and outpatient facilities. While the inpatient care price per capita after radical prostatectomy decreased by 34% between 1992 and 2003, the average price of nonsurgical CaP admissions remained relatively flat. In both cases, the average price of nonsurgical CaP admissions remained relatively flat. The average price for physician services increased by $30 per service over the study period, however the quantity of per capita physicians for CaP increased by 43.9%. The services that were most accountable for spending growth included androgen deprivation therapy, radiotherapy, and chemotherapy. The cost of androgen deprivation therapy doubled from $988 per capita in 1992 to $1,891 per capita in 2003. For each of these therapies, usage, not price changes was the primary mechanism underlying the observed growth, accounting for 59% for ADT and 76% for IMRT.

Zhang Y, Skolarus TA, Miller DC, Wei JT, Hollenbeck BK

Urology. 2011 Feb;77(2):326-31



PubMed Abstract
PMID: 21168902

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