Financial implications of changes in the initial treatment of prostate cancer among Medicare beneficiaries.

6115 Background: The traditional treament approaches for localized prostate cancer have included androgen suppression, watchful waiting, open radical prostatectomy, external beam radiation therapy and interstitial brachytherapy. In the last decade a number of novel treatment options have been developed including minimally invasive radical prostatectomy (MIRP) and intensity-modulated radiation therapy (IMRT). METHODS: In this study, we examined changes in the treatment of Medicare beneficiaries diagnosed with incident prostate cancer between 1999 and 2007. The primary outcome was utiliziation of radiation, surgery, or androgen suppression therapy in the first 12 months following newly diagnosed prostate cancer by year of incidence. RESULTS: The study sample included 20 399 cases of incident prostate cancer identified between 1999 and 2007. Overall rates of surgery and radiotherapy within the first 12 months of diagnosis remained unchanged across the study period, however the proportion of beneficiaries receiving androgen suppression monotherapy decreased by half, with watchful waiting increasing from 16% to 23% of all beneficiaries. From 2002 to 2007, IMRT replaced 3-D conformal treatment as the most common method of prostate radiotherapy, and was used in two-thirds of all Medicare prostate cancer patients receiving any radiotherapy by 2007. During this same period, minimally invasive radical prostatectomy began to replace open surgical approaches, and was used in half of all radical prostatectomies by 2007. CONCLUSIONS: By 2007 IMRT had replaced 3D conformal radiotherapy (3D-CRT) as the predominant method of radiotherapy used in the Medicare prostate cancer population. With Medicare reimbursement for IMRT averaging $48,000 per beneficiary vs $22,000 for 3D-CRT, this trend has significant budgetary implications. The aging of the US population over the next decade will cause the number of men with newly diagnosed prostate cancer to climb. When combined with growth in the use of newer high-cost technologies, Medicare spending for prostate cancer will further accelerate.

Duke Scholars

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