MP15-01 CONTEMPORARY ANALYSIS OF MEDICARE REIMBURSEMENTS RELATED TO TREATMENT OF LOCALIZED PROSTATE CANCER

Abstract

INTRODUCTION AND OBJECTIVES: Throughout the last decade, important changes occurred in the assignment of initial management options for localized prostate cancer (PCa) patients. Specifically, the rate of conservative management (CM) increased and a decline in the use of primary androgen deprivation therapy (PADT) has been observed. We examined the impact of these changes on the annual distribution of Medicare reimbursements. METHODS: Between 2000 and 2008, in Surveillance Epidemiology and End Results (SEER)-Medicare-linked database, we identified 155,876 patients with localized PCa. We assessed the median annual Medicare reimbursements trends for each treatment modality (CM, radiation therapy-RT-, radical prostatectomy-RPand PADT) and the trends of each treatment’s contribution to the proportion of the total annual Medicare reimbursement amounts, after adjusting for patient and tumor characteristics. Lowess smoother weighted functions with corresponding 95% confidence interval were used to plot all graphs. Linear regression tested the slope of recorded annual trends. RESULTS: Between 2000 and 2008, RT median reimbursement amounts were the highest ($29,035 to $28,634; p1⁄40.9). RT accounted for 63.3% of the total amounts in 2000 and for 73.6% in 2008 (p<0.001). The median reimbursement amounts for PADT and RP decreased during the study period ($20,645 to $9,992 for PADT; $18,093 to $16,483 for RP; all p 0.002). PADT ranked second on the total amounts between year 2000 (21.6%) and 2005 (12.6%) and third thereafter. RP ranked third on the total amounts between year 2000 (13.3%) and 2005 (10.3%) and second thereafter. The median reimbursement amounts for CM increased from $1,259 in 2000 to $1,712 in 2008 (p<0.001). CM ranked fourth on the total amounts between year 2000 (1.8%) and 2008 (3.4%). The total reimbursement amounts for all four treatment modalities decreased from a maximum of $446,787,109 in 2002 to its lowest amount of $244,601,498 in 2008. CONCLUSIONS: A decline of Medicare reimbursement amounts for treatment of localized PCa was observed between 2000 and 2008. RT Medicare reimbursement amounts represent the major contributor to the total annual reimbursement amounts for management of localized PCa and on an individual basis RT represents the most expensive of all four examined treatment modalities. PADT, RP and CM only contribute to a fraction of the total amounts. These facts and figures related to reimbursements and cost of localized PCa treatments are important to know at the time of medical decision-making.