MP48-02 PRACTICE COMPETITION AND TREATMENT OF NEWLY DIAGNOSED PROSTATE CANCER

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You have accessJournal of UrologyCME1 Apr 2023MP48-02 PRACTICE COMPETITION AND TREATMENT OF NEWLY DIAGNOSED PROSTATE CANCER Avinash Maganty, Samuel Kaufman, Mary Oerline, Lillian Lai, Megan Caram, Brent Hollenbeck, and Vahakn Shahinian Avinash MagantyAvinash Maganty More articles by this author , Samuel KaufmanSamuel Kaufman More articles by this author , Mary OerlineMary Oerline More articles by this author , Lillian LaiLillian Lai More articles by this author , Megan CaramMegan Caram More articles by this author , Brent HollenbeckBrent Hollenbeck More articles by this author , and Vahakn ShahinianVahakn Shahinian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003294.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Financial incentives can affect management of prostate cancer, particularly in circumstances in which the decision to treat is discretionary. Consolidation of physician practices can lead to reduction in market competition and higher prices, which may influence behavior around prostate cancer care. The extent to which urology practice market competition impacts use of treatment in men with newly diagnosed prostate cancer is unclear. METHODS: We performed a retrospective national cohort study of 48,067 Medicare beneficiaries with newly diagnosed prostate cancer between 2014 and 2018. The primary exposure was urology practice-level market competition. Markets were established by the flow of patients to a practice using a variable radius approach. Practice level competition was measured annually using the Herfindahl-Hirschman Index (HHI). The primary outcome was use of treatment for prostate cancer (i.e., surgery, radiation, or cryotherapy) stratified by 10-year risk of non-cancer mortality. RESULTS: Between 2014 and 2018, there was a decrease in the total percent of urologists practicing in small single specialty groups (49% to 41%) with an increase in multispecialty practices (38% to 47%). After adjusting for demographic and clinical characteristics, a lower percentage of men underwent treatment in practices with low competition relative to those managed in practices with high competition (67% vs 70%, p<0.001). Among men with the highest risk of non-cancer mortality, those managed in practices in the least competitive markets were less likely to receive treatment relative to men managed by practices in the most competitive markets (48% vs. 60%, p<0.001). CONCLUSIONS: Reduction in competition between urology practices is not associated with greater use of treatment in men with newly diagnosed prostate cancer, particularly in those with a high risk of non-cancer mortality. Source of Funding: Avinash Maganty is supported by funding from the National Cancer Institute Postdoctoral Fellow Award F32 Grant F32 CA275021-01This work is also supported by a Research Scholar Grant from the American Cancer Society (RSGI-21-097-01-HOPS) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e654 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Avinash Maganty More articles by this author Samuel Kaufman More articles by this author Mary Oerline More articles by this author Lillian Lai More articles by this author Megan Caram More articles by this author Brent Hollenbeck More articles by this author Vahakn Shahinian More articles by this author Expand All Advertisement PDF downloadLoading ...