131 CERTIFICATE OF NEED LAWS AND THE DIFFUSION OF INTENSITY-MODULATED RADIOTHERAPY

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2012131 CERTIFICATE OF NEED LAWS AND THE DIFFUSION OF INTENSITY-MODULATED RADIOTHERAPY Bruce L. Jacobs, Yun Zhang, and Brent K. Hollenbeck Bruce L. JacobsBruce L. Jacobs Ann Arbor, MI More articles by this author , Yun ZhangYun Zhang Ann Arbor, MI More articles by this author , and Brent K. HollenbeckBrent K. Hollenbeck Ann Arbor, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.180AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intensity-modulated radiotherapy (IMRT) has disseminated rapidly, largely due to its purported improvements in cancer control and toxicity profile. While IMRT requires a substantial initial investment, it also creates opportunities for significant reimbursement, which raises the concern for overutilization. In this context, some states have implemented certificate of need laws (CONs), which have varying degrees of stringency, to curb the adoption of expensive, yet unproven services. How CONs affect the use of IMRT is unknown. We examined the dissemination of IMRT in markets with differing levels of CON stringency. METHODS We used Surveillance, Epidemiology, and End Results (SEER)-Medicare data to identify men diagnosed with prostate cancer between 2001 and 2007 who underwent treatment with radiation (n= 57,749), of which 23,545 had IMRT. We aggregated these data to Hospital Service Areas (HSAs), which represent local healthcare markets for hospital care. Information on CONs was obtained from the National Directory of Health Planning, Policy, and Regulatory Agencies. We categorized HSAs as markets having no CONs, low-stringency CONs (i.e., equipment threshold >$1.5 million), or high-stringency CONs (i.e., equipment threshold <$1.5 million). This cutoff was chosen due to the approximate cost of IMRT equipment. Our primary outcome was the adjusted proportion of IMRT among those patients receiving radiation in a given market. RESULTS After excluding markets with <10 patients treated with radiation in a given year, we identified 684 markets. The overall proportion of IMRT utilization was 35%, 44%, and 46% for no CON, low-stringency CON, and high-stringency CON markets, respectively (p<0.01). Over time, the adjusted proportion of patients treated with IMRT increased dramatically, regardless of CON regulation. For each year, markets with any form of CONs (i.e., high or low stringency) had similar use of IMRT, however both of these markets demonstrated higher utilization of IMRT than markets without CONs (p<0.01). CONCLUSIONS Any level of CON regulation, regardless of stringency, does not appear to inhibit the use of IMRT. Given IMRT's unproven benefits and favorable reimbursement, the failure of CONs to curb utilization raises concerns for overtreatment. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e54 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bruce L. Jacobs Ann Arbor, MI More articles by this author Yun Zhang Ann Arbor, MI More articles by this author Brent K. Hollenbeck Ann Arbor, MI More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...