Decreasing Use of Luteinizing Hormone-Releasing Hormone Agonists in the United States is Independent of Reimbursement Changes: A Medicare and Veterans Health Administration Claims Analysis

Abstract

Luteinizing hormone-releasing hormone agonists are the most common form of androgen deprivation therapy in men with prostate cancer. Limited data exist regarding physician decision-making in prescribing luteinizing hormone-releasing hormone agonists. We present an analysis of luteinizing hormone-releasing hormone agonist use trends based on a time matched comparison of data from Medicare and the Veterans Health Administration, a health care system unaffected by recent changes in Medicare reimbursement implemented by the Medicare Modernization Act in 2004. Medicare claims and payment data were obtained from the Centers for Medicare and Medicaid Services from 2003 to 2007 for luteinizing hormone-releasing hormone agonists and for simple orchiectomy. The Veterans Health Administration Pharmacy Benefits Management database was queried for the annual number of prescriptions for luteinizing hormone-releasing hormone agonists during the same period. After implementation of the Medicare Prescription Drug, Improvement and Modernization Act in 2004 the reimbursement of luteinizing hormone-releasing hormone agonists in the Medicare population decreased by 54.8% and annual claims decreased by 25.1% from 2004 to 2007. During the same period luteinizing hormone-releasing hormone agonist use decreased by 16.8% in the Veterans Health Administration population. There was no compensatory increase in the use of simple orchiectomy for androgen deprivation therapy during the study period. Use of luteinizing hormone-releasing hormone agonists has decreased in the Medicare and Veterans Health Administration populations since 2004 without a compensatory increase in the use of alternative forms of androgen deprivation therapy. The shift in practice patterns is likely due to a decrease in Medicare reimbursement for these drugs, an increase in the use of intermittent therapy and increased recognition of the adverse effects associated with androgen deprivation therapy.