Medicare Reimbursement Policy Change Significantly Reduces ADT Therapy For Prostate Cancer Treatment Claims.

According to a group of researchers deducted from their observations, that 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.

In order to conduct the research the team used the Surveillance, Epidemiology, and End Results (SEER) Medicare database, and found 54,925 men who received a diagnosis of incident prostate cancer from 2003 through 2005. Then the team 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. The team used modified Poisson regression models to calculate the effect of the year of diagnosis on the use of ADT.

The outcome of the research indicates that 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. 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.

NEJM