Researchers Probe Concurrent Timing of ADT Use Drop and Medicare Reimbursement Policy Change

May 2010, Vol 1, No 1

San Francisco, CA—By mining the Surveillance, Epidemiology and End Results-Medicare Database, researchers have documented a significant de cline in nonevidence-based use of androgen deprivation therapy (ADT) for prostate cancer between 2003 and 2005. This coincides with a significant drop in Medicare reimbursement in 2004 for the form of ADT known as a gona dotropin-releasing hormone agonist.

In the database there were 54925 men with prostate cancer newly diagnosed between 2003 and 2005, 43.2% of whom used ADT.

The rate of evidence-based ADT use among those 43.2% remained roughly steady at around 80% over that period. “Nonevidence-based use of androgen deprivation therapy fell from 38.7% in 2003, to 30.7% in 2004, and to 25.7% in 2005.”

The investigators created a modified Poisson regression analysis model that confirmed nonevidence-based ADT use dropped: there was a 0.72 odds ratio of use in 2005 compared with 2003.

They presented the results at the ASCO 2010 Genitourinary Cancers Symposium.

The question remains, however, what the main driver of the drop was.

Lead researcher Vahakn Shahinian, MD, MS, assistant professor of medicine, University of Michigan School of Medicine, Ann Arbor, and his co-investigators seem to believe it was the change in reimbursement. But David Penson, MD, MPH, professor of urologic surgery and director, Vanderbilt Center for Surgical Quality and Outcome Research, Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tenn, thinks it may be more complicated than that.

He points out that around the sametime, several papers were published—including one with Dr Shahinian as the lead author (N Engl J Med. 2005; 352[2]:154-156)—that documented significant adverse events from ADTs.

“It is likely that this also played an important role in changes in ADT patterns of care in the first decade of the 21st century,” Dr Penson concluded, when discussing the study with Value-Based Cancer Care.

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