1819 MANAGED CARE AND THE DIFFUSION OF INTENSITY-MODULATED RADIOTHERAPY FOR PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Localized IX1 Apr 20121819 MANAGED CARE AND THE DIFFUSION OF INTENSITY-MODULATED RADIOTHERAPY FOR PROSTATE CANCER 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.2012.02.1885AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intensity-modulated radiotherapy (IMRT) for the treatment of prostate cancer has rapidly disseminated over the last decade. Its improved targeting capabilities and delivery of higher doses of radiation are thought to result in numerous patient benefits, including reduced bowel and urinary toxicity and improved cancer control. However, IMRT is expensive. How this affects its dissemination in markets with varying degrees of managed care remains unknown. We examined the relationship between managed care penetration and IMRT utilization. METHODS Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified a retrospective cohort of men diagnosed with prostate cancer between 2001 and 2007 who underwent treatment with radiation (n= 57,749), of which 23,545 received IMRT. We aggregated these data to the market level, defined as a Hospital Service Area (HSA). HSAs represent local healthcare markets for hospital care. For a given year, we excluded HSAs with < 10 patients treated with radiation, which resulted in 684 HSA-years. We used the Area Resource File to obtain the managed care penetration for each HSA. Then, we compared markets with high and low managed care penetration. Our primary outcome was the adjusted proportion of IMRT use among those patients receiving radiation. RESULTS Over this 7-year period, the proportion of IMRT utilization substantially increased across all markets. After adjusting for income, education, race, and diagnosis year, the overall proportion of IMRT use was 38% and 39% in markets with low and high managed care penetration, respectively (p<0.01). Patients living in markets with higher managed care penetration used IMRT more frequently. CONCLUSIONS Despite IMRT's high cost, its overall dissemination was not deterred by managed care penetration. While statistically significant, the effect of managed care penetration on IMRT utilization appears small. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e735 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 ...