MP39-06 DISPARITY IN COST AND HEALTH SERVICE USE IN TERMINAL PHASE AMONG PROSTATE CANCER PATIENTS

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP39-06 DISPARITY IN COST AND HEALTH SERVICE USE IN TERMINAL PHASE AMONG PROSTATE CANCER PATIENTS Ravishankar Jayadevappa, S Bruce Malkowicz, Thomas Guzzo, and Sumedha Chhatre Ravishankar JayadevappaRavishankar Jayadevappa More articles by this author , S Bruce MalkowiczS Bruce Malkowicz More articles by this author , Thomas GuzzoThomas Guzzo More articles by this author , and Sumedha ChhatreSumedha Chhatre More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003277.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Research shows considerable racial and ethnic variation in the structure and process of care that has implications for care choices and cost. Objective is to assess the racial and ethnic disparity in the cost and health service use in terminal phase among prostate cancer patients. METHODS: Population-based cohort study using data from Surveillance, Epidemiological, and End Results-Medicare (SEER-Medicare). Cohort consisted of patients diagnosed with prostate cancer between 1996 and 2013, and deceased as of 12/31/2013. One-year period prior to death was considered as terminal phase. We operationalized cost as sum of Medicare reimbursement for inpatient, outpatient and provider services. Cost during the terminal phase was assessed for four racial and ethnic groups: African American, white, Hispanic and other. We used GLM model for cost and Poisson models for health service use. Independent variable were socio-demographic and clinical characteristics. RESULTS: Between 1996 and 2013, 788,217 Medicare beneficiaries were diagnosed with prostate cancer, of which, 314,861 (39%) were deceased by end of year 2013 and constituted the study cohort. In our cohort, African American patient were youngest (mean age 71.6 years, standard deviation (Std) 8.9), and white patients were oldest (mean 74.9, std 8.5). GLM model indicated that race, age, and comorbidity were associated with cost. The health service use varied between racial and ethnic groups. A longitudinal comparison of mean cost in terminal phase for the four racial and ethnic groups is presented in Figure 1. The mean cost for all racial and ethnic groups increased over time; and African American patients had highest cost in all years, compared to other groups. CONCLUSIONS: This study is first of its kind to assess longitudinally the cost of terminal phase and associated disparity. The terminal phase cost almost doubled between 1995 and 2013, for all racial and ethnic groups, and continued to be highest for African American patients. Future studies need to address the overuse, underuse and misuse of care that may contribute to the high cost burden in the terminal phase and the associated racial and ethnic disparity in cost and health service use. Source of Funding: DoD W81XWH-19-1-0461 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e536 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ravishankar Jayadevappa More articles by this author S Bruce Malkowicz More articles by this author Thomas Guzzo More articles by this author Sumedha Chhatre More articles by this author Expand All Advertisement PDF downloadLoading ...