Study shows drop in unnecessary ADT after decline in reimbursement

When Medicare policy changes led to reductions in reimbursement for androgen deprivation therapy in prostate cancer patients, a sharp decline in its use was seen among patients not likely to benefit from the treatment, reported researchers from the University of Michigan, Ann Arbor.

Among patients for whom the therapy is clearly beneficial, however, physicians continued to prescribe it at the same rate, the researchers wrote in the New England Journal of Medicine (2010; 363:1822-32).

This finding, according to the researchers, suggests that financial reform of health care can reduce unnecessary care without impacting care to those patients most likely to benefit from a treatment.

"We found that physicians respond to reimbursement, but they respond in a way that appears to be beneficial to the patient," said lead author Vahakn B. Shahinian, MD. "They don’t tend to cut out necessary care, but they tend to cut out unnecessary or inappropriate care. This suggests cutting reimbursements in the right context can help reduce unnecessary care."

Dr. Shahinian and his colleagues looked at data from 54,925 men treated for prostate cancer from 2003 to 2005, using the Surveillance, Epidemiology and End Results-Medicare database. Patients were separated into three categories of ADT use based on the characteristics of their disease and the other treatment they received: appropriate use, potentially inappropriate use, and discretionary.

Over the course of the Medicare reimbursement cuts, use of ADT stayed steady for patients in the appropriate use category. Inappropriate use, however, dropped from 39% at the end of 2003 to 22% by the end of 2005. The discretionary group also declined, but more moderately.In that time, reimbursements for ADT fell from $356 per dose in 2003 under the initial reimbursement to $176 per dose in 2005 under the revised reimbursement.