DECREASING UTILIZATION OF LHRH-AGONISTS IN THE UNITED STATES IS INDEPENDENT OF REIMBURSEMENT CHANGES: A MEDICARE AND VETERANS HEALTH ADMINISTRATION CLAIMS ANALYSIS

Abstract

INTRODUCTION AND OBJECTIVE: Partial nephrectomy is an established standard for treatment of localized RCC. Unfortunately, NSS remains widely underutilized except at high-volume academic centers. We evaluated the potential impact of a patient’s primary insurance status as an independent variable predicting a patient’s likelihood of undergoing NSS using inpatient discharge data from New York (NY), New Jersey (NJ), and Pennsylvania (PA). METHODS: A database generated from discharge claims data of individual state agencies of NJ, NY, and PA, was queried for all patients =>18 years of age who underwent radical or partial nephrectomy from 2000 to 2006. We used multiple linear regressions to investigate effects of insurance status on likelihood of undergoing partial nephrectomy. RESULTS: 42,104 radical or partial nephrectomies were included in the analysis. The total number of procedures performed increased annually (Figure 1). On univariate analysis, likelihood of undergoing NSS was associated with age, gender, hospital procedure volume, socioeconomic status, payer, and rurality. In the multivariate analysis, older patients (p 65 (n= 26,600), patients with Medicare as the primary payer (n=18,811) were less likely to undergo NSS (OR=0.76, CI 0.70, 0.81) than patients who had a private provider as the primary payer (n=6,684; OR=1.00). CONCLUSIONS: Disparities in quality of care exist. By examining a large discharge claims database from NY, NJ, and PA, we were able to show that patients =>65 years of age with Medicare coverage were 24% less likely to undergo nephron sparing surgery for treatment of renal malignancy than patients whose primary payer was a private insurance carrier. Reasons for these findings require further investigation.