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Initial Treatment of Prostate Cancer in Medicare Moving Toward High-Cost Technologies

August 2011 Vol 4, No 4, Special Issue - Prostate Cancer

The combination of an aging population and the use of newer highcost technologies will accelerate future Medicare spending for prostate cancer, according to Michaela A. Dinan, PhD, and colleagues from the Duke Clinical Research Institute, Durham, NC.

Dr Dinan and colleagues analyzed current trends in the treatment of patients with prostate cancer who are Medicare beneficiaries, showing that the more expensive, intensity-modulated radiation therapy (IMRT) has replaced 3-dimensional conformal radiotherapy (3D-CRT) as the primary form of radiotherapy for this patient population.

Using a nationally representative 5% sample of claims from the Centers for Medicare & Medicaid Services, the investigators conducted a retrospective claims-based review of radiation therapy, surgery, and androgen-deprivation therapy in the first 12 months after a diagnosis of prostate cancer.

The study included 20,399 Medicare beneficiaries aged ≥67 years, with incident prostate cancer that was diagnosed between 1999 and 2007.

The overall rates of surgery and radiotherapy remained unchanged during the first 12 months of diag - nosis across the study period, but those receiving androgen-deprivation mono therapy decreased by approximately half between 2003 (25.6%) and 2007 (14.1%).

The proportion of patients without evidence of active treatment increased from 14.7% in 2003 to 22.5% in 2007. Minimally invasive radical prostatectomy replaced open approaches and comprised 50% of all radical prostatectomies by 2007.

“IMRT replaced 3D-CRT as the most common method of prostate radiotherapy from 2002 to 2007 and was used in two thirds of all Medicare prostate cancer patients receiving any radiotherapy by 2007,” Dr Dinan and colleagues noted.

The increasing trend favoring the use of IMRT over 3D-CRT has significant financial implications, because Medicare reimbursement for IMRT averages $48,000 compared with only $22,000 for 3D-CRT.

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Last modified: August 30, 2021