MP48-12 ASSESSING THE IMPACT OF VETERANS HEALTH ADMINISTRATION CHOICE LEGISLATION ON TREATMENT OF LOW-RISK PROSTATE CANCER IN RURAL VETERANS

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP48-12 ASSESSING THE IMPACT OF VETERANS HEALTH ADMINISTRATION CHOICE LEGISLATION ON TREATMENT OF LOW-RISK PROSTATE CANCER IN RURAL VETERANS Bradley Erickson, Richard Hoffman, Jason Wachsmuth, and Mary Vaughan-Sarrazin Bradley EricksonBradley Erickson More articles by this author , Richard HoffmanRichard Hoffman More articles by this author , Jason WachsmuthJason Wachsmuth More articles by this author , and Mary Vaughan-SarrazinMary Vaughan-Sarrazin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003294.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The 2014 Veterans Choice (Choice) Legislation provided unprecedented access to non-Veterans Health Administration (VHA) healthcare facilities for men living > 40 miles from their closest VHA tertiary facility and/or men experiencing wait times for specialized care of > 60 days. The study purpose was to determine how non-VHA care supported by Choice affected receipt of definitive treatment (prostatectomy/radiation therapy) for low-risk prostate cancer (CaP) – a patient group for whom conservative treatment is strongly recommended by guidelines. METHODS: The cohort included 45,685 men diagnosed with CaP from 2015-2018 who regularly used the VHA. We used VHA claims data and the VA Program Integrity Tool to identify care provided inside and outside (Choice funded) of VHA facilities, respectively. The primary outcomes were 1) definitive CaP care for Grade Group 1 (GG1; Gleason 3+3 or less) CaP and 2) definitive care for men diagnosed at age >70 with PSA < 10 ng/mL. We used multivariable modeling to determine the relationships between patient, facility, tumor characteristics, and biopsy location with receipt of definitive care. RESULTS: We identified 10,499 (23%) men in the cohort with GG1 disease, of which 4097 (39%) underwent definitive treatment (Table). Definitive treatment among GG1 was predicted by lower age (RR 0.98), higher PSA (RR 1.53), Black (non-Hispanic) race (RR 1.1), distance from tertiary VHA (40-90 miles RR 1.15; > 90 miles RR 1.11) and non-VHA diagnostic biopsy location (RR 1.29). There were 6445 (14%) men with CaP that were older than 70 with PSA <10, of which 3836 (60%) underwent definitive treatment. Definitive treatment was predicted by higher Gleason Grade Group (2/3 RR 2.44; 4/5 RR 2.65), lower age (RR 0.97) and non-VHA diagnostic biopsy location (RR 1.16). CONCLUSIONS: We found significant differences in managing low-risk CaP between Veterans receiving care in the VHA and those using their Choice eligibility to receive outside care. The location of the diagnostic biopsy appears to have the greatest impact on treatment and thus may represent a potential target of intervention to minimize the risk of overtreating Veterans with CaP by decreasing care fragmentation. Source of Funding: U.S. Department of Veterans Affairs Office of Rural Health (OMAT 16010) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e659 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bradley Erickson More articles by this author Richard Hoffman More articles by this author Jason Wachsmuth More articles by this author Mary Vaughan-Sarrazin More articles by this author Expand All Advertisement PDF downloadLoading ...