Journal ArticleDOI
Reimbursement policy and androgen-deprivation therapy for prostate cancer.
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Changes in the Medicare reimbursement policy in 2004 and 2005 were associated with reductions in ADT use, particularly among men for whom the benefits of such therapy were unclear.Abstract:
BACKGROUND The Medicare Modernization Act led to moderate reductions in reimbursement for androgen-deprivation therapy (ADT) for prostate cancer, starting in 2004 and followed by substantial changes in 2005. We hypothesized that these reductions would lead to decreases in the use of ADT for indications that were not evidence based. METHODS Using the Surveillance, Epidemiology, and End Results (SEER) Medicare database, we identified 54,925 men who received a diagnosis of incident prostate cancer from 2003 through 2005. We divided these men into groups according to the strength of the indication for ADT use. The use of ADT was deemed to be inappropriate as primary therapy for men with localized cancers of a low-to-moderate grade (for whom a survival benefit of such therapy was improbable), appropriate as adjuvant therapy with radiation therapy for men with locally advanced cancers (for whom a survival benefit was established), and discretionary for men receiving either primary or adjuvant therapy for localized but high-grade tumors. The proportion of men receiving ADT was calculated according to the year of diagnosis for each group. We used modified Poisson regression models to calculate the effect of the year of diagnosis on the use of ADT. RESULTS The rate of inappropriate use of ADT declined substantially during the study period, from 38.7% in 2003 to 30.6% in 2004 to 25.7% in 2005 (odds ratio for ADT use in 2005 vs. 2003, 0.72; 95% confidence interval [CI], 0.65 to 0.79). There was no decrease in the appropriate use of adjuvant ADT (odds ratio, 1.01; 95% CI, 0.86 to 1.19). In cases involving discretionary use, there was a significant decline in use in 2005 but not in 2004. CONCLUSIONS Changes in the Medicare reimbursement policy in 2004 and 2005 were associated with reductions in ADT use, particularly among men for whom the benefits of such therapy were unclear. (Funded by the American Cancer Society.).read more
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Prostate-Specific Membrane Antigen Positron Emission Tomography-Computed Tomography for Prostate Cancer: Distribution of Disease and Implications for Radiation Therapy Planning.
Sandeep K. Gupta,Tahne Watson,James W. Denham,James W. Denham,Thomas P. Shakespeare,Natalie Rutherford,Nicholas McLeod,Kevin Picton,Paul Ainsworth,Tony Bonaventura,Tony Bonaventura,Jarad Martin,Jarad Martin +12 more
TL;DR: Prostate-specific membrane antigen PET demonstrated a large number of otherwise unknown metastatic lesions, and is recommended for more accurate assessment of disease burden in initial staging of high-risk PC, as well as for restaging in patients with prostate-specific antigen relapse after primary therapies.
Journal ArticleDOI
Adverse effects of androgen deprivation therapy for prostate cancer: prevention and management
TL;DR: Although androgen suppression therapy may be associated with significant and sometimes durable responses, it is not considered a cure and its potential efficacy is further limited by an array of significant and bothersome adverse effects caused by the suppression of androgens.
Journal ArticleDOI
Changes in Initial Treatment for Prostate Cancer Among Medicare Beneficiaries, 1999–2007
Michaela A. Dinan,Timothy J. Robinson,Timothy M. Zagar,Charles D. Scales,Lesley H. Curtis,Shelby D. Reed,W. Robert Lee,Kevin A. Schulman +7 more
TL;DR: Between 2002 and 2007, the use of androgen deprivation therapy decreased, open surgical approaches were largely replaced by minimally invasive radical prostatectomy, and intensity-modulated radiation therapy replaced three-dimensional conformal radiation therapy as the predominant method of radiation therapy in the Medicare population.
Journal ArticleDOI
Patterns of Declining Use and the Adverse Effect of Primary Androgen Deprivation on All-cause Mortality in Elderly Men with Prostate Cancer.
Jesse D. Sammon,Firas Abdollah,Gally Reznor,Daniel Pucheril,Toni K. Choueiri,Jim C. Hu,Simon P. Kim,Marianne Schmid,Akshay Sood,Maxine Sun,Adam S. Kibel,Paul L. Nguyen,Mani Menon,Quoc-Dien Trinh +13 more
TL;DR: It is found that pADT is detrimental to men with localized prostate cancer, and particularly men with longer life expectancy, and therefore ADT should not be used as a primary treatment for men with prostate cancer that has not spread beyond the prostate.
Journal ArticleDOI
Cardiovascular risk and bone loss in men undergoing androgen deprivation therapy for non-metastatic prostate cancer: implementation of standardized management guidelines
Ada S Cheung,David A. Pattison,Ingrid Bretherton,Rudolf Hoermann,D. Lim Joon,E. Ho,Trish Jenkins,Emma J. Hamilton,Katherine Bate,I. Chan,Jeffrey D Zajac,Mathis Grossmann +11 more
TL;DR: It is concluded that a structured approach to assess and treat men undergoing ADT effectively improves cardiovascular risk factors and prevents bone decay.
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Development of a comorbidity index using physician claims data.
TL;DR: A comorbidity index that incorporates the diagnostic and procedure data contained in Medicare physician (Part B) claims and demonstrates the utility of a disease-specific index using an alternative method of construction employing study-specific weights.
PHARMACOEPIDEMIOLOGY REPORT Development of a comorbidity index using physician claims data
TL;DR: This article developed a comorbidity index that incorporates the diagnostic and procedure data contained in Medicare physician (Part B) claims, which significantly contributes to models of 2-year noncancer mortality and treatment received in both patient cohorts.