491 TIME TRENDS IN THE UTILIZATION OF HIGHER-COST TREATMENTS FOR PROSTATE CANCER, 2002-2007

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness II1 Apr 2010491 TIME TRENDS IN THE UTILIZATION OF HIGHER-COST TREATMENTS FOR PROSTATE CANCER, 2002-2007 Wesley Choi, Paul Nguyen, Xiangmei Gu, Stuart Lipsitz, Toni Choueiri, Yin Lei, Anthony D'Amico, and Jim Hu Wesley ChoiWesley Choi More articles by this author , Paul NguyenPaul Nguyen More articles by this author , Xiangmei GuXiangmei Gu More articles by this author , Stuart LipsitzStuart Lipsitz More articles by this author , Toni ChoueiriToni Choueiri More articles by this author , Yin LeiYin Lei More articles by this author , Anthony D'AmicoAnthony D'Amico More articles by this author , and Jim HuJim Hu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.566AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess temporal trends in the use of higher-cost therapies for non-metastatic prostate cancer (PCa) in the US from 2002-2007 METHODS We determined treatment patterns for 58,581 men aged ≥65 years diagnosed with non-metastatic PCa from 2002-2005 and treated through 2007 using Surveillance, Epidemiology, and End-Results (SEER) –Medicare linked data. Current Procedural Terminology 4th edition (CPT-4) codes were used to distinguish intensity-modulated radiation therapy (IMRT) vs. standard conformal beam radiation, and between minimally-invasive radical prostatectomy (MIRP) vs. open prostatectomy. Annual trends were compared with the Mantel-Haenszel trend test. RESULTS Treatment rates for cancer diagnosed in 2002 vs. 2005 were as follows: external radiation (29.8% vs 29.4%, p=0.33), surgery (18.9% vs. 21.5%, p<0.001), brachytherapy (15.5 vs. 16.0%, p=0.28), primary androgen deprivation therapy (20.5% vs 16.5%, p<0.001), and cryotherapy (1.3% vs. 3.0%, p<0.001). For surgery, the utilization of MIRP increased substantially over time (9.5% vs 28.7%, p<0.001), and for external radiation, IMRT utilization increased substantially (28.7% vs. 81.7%, p<0.001). Men receiving IMRT vs. standard radiation were more likely to live in areas with >90% high-school graduates (40.1% vs. 29.0%, p<0.001), with median annual income '$60,000 (20.9% vs. 12.3%, p<0.001), reside in the Northeast or West (72.1% vs. 69.2%, p=0.017), and were more likely to be non-white (23.5% vs. 22.1%, p=0.03). Men receiving MIRP vs. open prostatectomy were more likely to reside in areas with >90% high-school graduates (50.1% vs. 40.1%, p<0.001), with median annual income ≥$60,000 (35.4% vs. 21.1%, p<0.001), and live in the Northeast or West (72.1% vs. 69.2%, p=0.017). CONCLUSIONS Shifts in the relative use of surgery, radiation, and brachytherapy for prostate cancer were generally minor, but within surgery and radiation, use of higher-cost therapies increased dramatically despite limited comparative effectiveness outcomes assessment. Utilization of these higher cost therapies was more likely to occur in areas with >90% high school education, median annual income of ≥$60,000, and in the Northeast or West. Boston, MA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e194 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wesley Choi More articles by this author Paul Nguyen More articles by this author Xiangmei Gu More articles by this author Stuart Lipsitz More articles by this author Toni Choueiri More articles by this author Yin Lei More articles by this author Anthony D'Amico More articles by this author Jim Hu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...