Trends and Variation in Localized Prostate Cancer Treatment
Trends and Variation in Localized Prostate Cancer Treatment
Background Several treatment options for clinically localized prostate cancer currently exist under the established guidelines. We aim to assess nationally representative trends in treatment over time and determine potential geographic variation using two large national claims registries.
Methods Men with prostate cancer insured by Medicare (1998–2006) or a private insurer (Ingenix database, 2002–2006) were identified using International Classification of Diseases-9 and Current Procedural Terminology-4 codes. Geographic variation and trends in the type of treatment utilized over time were assessed. Geographic data were mapped using the GeoCommons online mapping platform. Predictors of any treatment were determined using a hierarchical generalized linear mixed model using the logit link function.
Results The use of radical prostatectomy increased, 33–48%, in the privately insured i3 database while remaining stable at 12% in the Medicare population. There was a rapid uptake in the use of newer technologies over time in both the Medicare and i3 cohorts. The use of laparoscopic-assisted prostatectomy increased from 1% in 2002 to 41% in 2006 in i3 patients, whereas the incidence increased from 3% in 2002 to 35% in 2006 for Medicare patients. The use of neoadjuvant/adjuvant androgen deprivation therapy was lower in the i3 cohort and has decreased over time in both i3 and Medicare. Physician density had an impact on the type of primary treatment received in the New England region; however, this trend was not seen in the western or southern regions of the United States.
Conclusions Using two large national claims registries, we have demonstrated trends over time and substantial geographic variation in the type of primary treatment used for localized prostate cancer. Specifically, there has been a large increase in the use of newer technologies (that is, laparoscopic-assisted prostatectomy and intensity-modulated radiation therapy). These results elucidate the need for improved data collection on prostate cancer treatment outcomes to reduce unwarranted variation in care.
Prostate cancer is estimated to account for nearly a third of all incident cancer types in men. With many therapeutic options available, localized prostate cancer treatment patterns are quite diverse. Some of these variations in treatment are likely explained by a lack of sufficient evidence to suggest a greater benefit of one treatment approach over another.
Variation in treatment attributable to local practice site has been shown to range from 13% for primary androgen deprivation therapy (ADT) to 74% for cryotherapy. This suggests that factors other than cancer risk and patient characteristics may influence treatment decisions. Furthermore, advances in both radiation and surgical technology have also led to changes in treatment patterns over time.
The aim of the current study is to confirm nationally representative trends in the use of primary treatment for localized prostate cancer in two large claims-based registries, representing men across the age spectrum and to assess demographic, geographic and clinical predictors of the treatment.
Abstract and Introduction
Abstract
Background Several treatment options for clinically localized prostate cancer currently exist under the established guidelines. We aim to assess nationally representative trends in treatment over time and determine potential geographic variation using two large national claims registries.
Methods Men with prostate cancer insured by Medicare (1998–2006) or a private insurer (Ingenix database, 2002–2006) were identified using International Classification of Diseases-9 and Current Procedural Terminology-4 codes. Geographic variation and trends in the type of treatment utilized over time were assessed. Geographic data were mapped using the GeoCommons online mapping platform. Predictors of any treatment were determined using a hierarchical generalized linear mixed model using the logit link function.
Results The use of radical prostatectomy increased, 33–48%, in the privately insured i3 database while remaining stable at 12% in the Medicare population. There was a rapid uptake in the use of newer technologies over time in both the Medicare and i3 cohorts. The use of laparoscopic-assisted prostatectomy increased from 1% in 2002 to 41% in 2006 in i3 patients, whereas the incidence increased from 3% in 2002 to 35% in 2006 for Medicare patients. The use of neoadjuvant/adjuvant androgen deprivation therapy was lower in the i3 cohort and has decreased over time in both i3 and Medicare. Physician density had an impact on the type of primary treatment received in the New England region; however, this trend was not seen in the western or southern regions of the United States.
Conclusions Using two large national claims registries, we have demonstrated trends over time and substantial geographic variation in the type of primary treatment used for localized prostate cancer. Specifically, there has been a large increase in the use of newer technologies (that is, laparoscopic-assisted prostatectomy and intensity-modulated radiation therapy). These results elucidate the need for improved data collection on prostate cancer treatment outcomes to reduce unwarranted variation in care.
Introduction
Prostate cancer is estimated to account for nearly a third of all incident cancer types in men. With many therapeutic options available, localized prostate cancer treatment patterns are quite diverse. Some of these variations in treatment are likely explained by a lack of sufficient evidence to suggest a greater benefit of one treatment approach over another.
Variation in treatment attributable to local practice site has been shown to range from 13% for primary androgen deprivation therapy (ADT) to 74% for cryotherapy. This suggests that factors other than cancer risk and patient characteristics may influence treatment decisions. Furthermore, advances in both radiation and surgical technology have also led to changes in treatment patterns over time.
The aim of the current study is to confirm nationally representative trends in the use of primary treatment for localized prostate cancer in two large claims-based registries, representing men across the age spectrum and to assess demographic, geographic and clinical predictors of the treatment.
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