MP23-01 NATIONAL TRENDS IN THE MANAGEMENT OF LOW RISK PROSTATE CANCER: ANALYZING THE IMPACT OF MEDICAID EXPANSION IN THE UNITED STATES

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I (MP23)1 Apr 2020MP23-01 NATIONAL TRENDS IN THE MANAGEMENT OF LOW RISK PROSTATE CANCER: ANALYZING THE IMPACT OF MEDICAID EXPANSION IN THE UNITED STATES Grant Pollock*, Jiping Zeng, and Juan Chipollini Grant Pollock*Grant Pollock* More articles by this author , Jiping ZengJiping Zeng More articles by this author , and Juan ChipolliniJuan Chipollini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000856.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We evaluated recent trends in the management of low risk prostate cancer (PCa) in the United States (US). Since little is known on factors affecting treatment patterns in era of the Affordable Care Act (ACA), our aims were to measure temporal trends and analyze factors contributing to adoption of surveillance based on state Medicaid expansion status. METHODS: Using the National Cancer Database, we identified men with PCa who resided in the 50 United States or District of Columbia with an incident diagnosis from 2012 to 2016. Men with histologically confirmed low risk PCa, defined as PSA less than 10 ng/ml, Gleason score 6 or less and cT1-T2a, were included. The Cochran Armitage test was used to evaluate trends in surveillance versus treatment across study period and comparisons between expansion and non-expansion states were performed. Univariable and multivariable logistic regression models were used to identify predictors for surveillance. RESULTS: The analytic cohort included 84,340 men. During the study period, surveillance as initial management in the US increased from 13.6% to 32.1% (p<0.01). When comparing by state Medicaid expansion status, expansion states had significantly higher rates of surveillance compared to non-expansion states (Figure 1). The expansion cohort had more white and Hispanic males, higher median income, lower morbidity and education status, and more privately insured and Medicaid patients compared to non-expansion states (all, p<0.05). After adjusting for clinical and demographic variables, Medicaid expansion was a significant predictor for surveillance (p<0.001) (Table 1). CONCLUSIONS: Based on data from 2012-2016, there has been a temporal increase in surveillance as initial management for low risk prostate cancer in the US. State Medicaid expansion was significantly associated with increased rates of surveillance versus treatment. Understanding the impact of payer status on health outcomes can aid in the development of future health care policies aiming to mitigate disparities. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e337-e337 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Grant Pollock* More articles by this author Jiping Zeng More articles by this author Juan Chipollini More articles by this author Expand All Advertisement PDF downloadLoading ...