74 REGIONAL VARIATION IN PROSTATE CANCER TREATMENT IS NOT CONSISTENT ACROSS AGE GROUPS

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness1 Apr 201174 REGIONAL VARIATION IN PROSTATE CANCER TREATMENT IS NOT CONSISTENT ACROSS AGE GROUPS David Penson, Daniel Barocas, and R. Lawrence Van Horn David PensonDavid Penson Nashville, TN More articles by this author , Daniel BarocasDaniel Barocas Nashville, TN More articles by this author , and R. Lawrence Van HornR. Lawrence Van Horn Nashville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.138AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Dartmouth Atlas of Healthcare has demonstrated considerable regional variation in the utilization of radical prostatectomy (RP) using Medicare data. This variation has been attributed to lack of evidence-based practice and local physician and patient preferences. It is possible, however, that the observed variation may also be related to market forces, such as insurance coverage. If it is independent of insurance coverage, one would expect to similar variation patterns in men under age 65, who are not covered by Medicare. The goal of the current study was to examine if the observed regional variation was consistent among across age groups. METHODS Using 2008 data from the Texas all-payor dataset, we identified all men with a primary diagnosis of prostate cancer (ICD-9:185) and an AP-DRG of 480 (radical prostatectomy). We restricted analysis to men over age 40. We then calculated age- and race-adjusted RP rates per 1000 men by county of residence. RESULTS We identified all 4186 men over age 40 who underwent radical prostatectomy of any type in the state of Texas in 2008. There was significant geographic variation by race and age in RP utilization, and importantly, the pattern of variation was different for older vs. younger men (figure). In regions where RP utilization was lower in younger men, such as the Lubbock area or the southwestern part of the state, utilization was considerably higher in men of Medicare age. The converse was true as well. CONCLUSIONS Regional variation in the utilization of RP is not consistent across age groups. This underscores the importance of looking beyond just Medicare data when addressing policy issues in health services research. More importantly, it sheds light on why regional variation may exist. RP utilization in men over 65 may be driven in part by consistent and reliable Medicare reimbursement, whereas the variability in insurance coverage among younger men may result in different geographic, socio-economic and racial patterns of utilization. Further research is needed to confirm this hypothesis. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e32 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Penson Nashville, TN More articles by this author Daniel Barocas Nashville, TN More articles by this author R. Lawrence Van Horn Nashville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...