Longitudinal patterns of cost and utilization of medicare beneficiaries with bladder cancer

BackgroundBladder cancer (BC) is highly prevalent and costly. This study documented cost and use of services for BC care and for other (non-BC) care received over a 15-year follow-up period by a cohort of Medicare beneficiaries diagnosed with BC in 1998.MethodsData came from the Surveillance, Epidemiology and End Results Program linked to Medicare claims. Medicare claims provided data on diagnoses, services provided, and Medicare Parts A and B payments. Cost was actual Medicare payments to providers inflated to 2018 US$. Cost and utilization were BC-related if the claim contained a BC diagnosis code. Otherwise, costs were for “other care.” For utilization, we grouped Part B-covered services into 6 mutually-exclusive categories. Utilization rates were ratios of the count of claims in a particular category during a follow-up year divided by the number of beneficiaries with BC surviving to year-end.ResultsCumulatively over 15-years, for all stages combined, total BC-related cost per BC beneficiary was $42,011 (95% Confidence Interval (CI): $42,405–$43,417); other care cost was about twice this number. Cumulative total BC-related cost of 15-year BC survivors for all stages was $43,770 (CI: $39,068–$48,522), intensity of BC-related care was highest during the first year following BC diagnosis, falling substantially thereafter. After follow-up year 5, there were few statistically significant changes in BC-related utilization. Utilization of other care remained constant during follow-up or increased.ConclusionsSubstantial costs were incurred for non-BC care. While increasing BC survivorship is an important objective, non-BC care would remain a burden to Medicare.     

Association of reimbursement policy and urologists׳ characteristics with the use of medical androgen deprivation therapy for clinically localized prostate cancer

ObjectivesPhysician characteristics and changes in drug reimbursement rates have been shown to influence practice patterns regardless of clinical guidelines, patient, clinical, or sociodemographic factors. We concurrently examined the association between urologists? characteristics and non–evidence-based use of primary medical androgen deprivation therapy (ADT) for clinically localized patients with prostate cancer, before and after the 2003 Medicare Modernization Act?s reductions in ADT reimbursement rates.Methods and materialsThe Surveillance, Epidemiology, and End Results-Medicare–linked database and the American Medical Association Physician Masterfile are used in a retrospective analysis of 12,255 patients diagnosed between 2001 and 2007 with clinical stage T1-T2, low- to intermediate-grade prostate cancer, and the 1,863 urologists who treated them. Logistic multilevel regression analyses are used to evaluate the association of urologists? characteristics on ADT use among patients within 6 months of diagnosis.ResultsOverall, 3,866 (32%) patients received non–evidence-based ADT. After adjusting for patient and urologist characteristics, patients treated by urologists with no medical school affiliations, compared with those treated by urologists with major medical school affiliations, are significantly more likely to receive non–evidence-based medical ADT (odds ratio = 2.35; 95% CI: 1.71–3.23; P<0.0001). Non–US-trained urologists are also more likely to prescribe non–evidence-based medical ADT (odds ratio = 1.64; 95% CI: 1.33–2.04; P<0.0001).ConclusionsPatients treated by non–medical school–affiliated or non–US-trained urologists or both are significantly more likely to receive non–evidence-based ADT before and after the passage of the Medicare Modernization Act. Better strategies to encourage evidence-based ADT use on clinically localized patients with prostate cancer may be of benefit especially among non–medical school–affiliated or non–US-trained urologists or both.     

Comparison of patient demographics and patient-related risk factors for dislocations following reverse shoulder arthroplasty

BackgroundDislocations following primary reverse total shoulder arthroplasty (rTSA) are a feared and concerning complication. With the increasing number of reverse total shoulder arthroplasty (rTSA) procedures being performed worldwide e, studies evaluating risk factors for dislocation following this procedure are limited. The purpose of this study was to utilize a large claims database to identify patient-related risk factors associated with dislocations following primary rTSA.MethodsA retrospective query of the Part A and Part B 100% Medicare Standard Analytical Files (SAF) claims database was performed identifying patients who underwent primary rTSA for the treatment of glenohumeral osteoarthritis. The inclusion criteria for the study group consisted of all patients who had a dislocation within 2-years following the index procedure. Patients with a record of other arthroplasty-type procedures were excluded. The query yielded 30,670 patients with (n = 703) and without (n = 29,967) dislocations. Multivariate binomial logistics regression analysis was performed to calculate odds (OR) on the impact of patient-related risk factors for dislocations following primary rTSA. A P value less than .002 was considered statistically significant.ResultsStudy group patients that sustained a dislocation following primary rTSA were generally younger than the age of 65 (16.8 vs. 8.3%) and male (59.6 vs. 38.8%). Study group patients had a higher comorbidity burden, as demonstrated by higher mean Elixhauser-Comorbidity Index (ECI) scores (9 vs. 6, P < .0001). The greatest risk factors for dislocations included being male (OR: 3.06, P < .0001), opioid use disorder (OR: 1.74, P = .0007), hypertension (OR: 1.56, P = .001), morbid obesity (OR: 1.43, P < .0001), electrolyte and fluid derangements (OR: 1.29, P = .0001), and depressive disorders (OR: 1.23, P = .0001).ConclusionAs the number of primary rTSA procedures increase worldwide, identification of patient-related risk factors for dislocations is of great importance. The study showed the greatest risk factors for dislocations included male sex with modifiable risk factors being opioid use disorder, hypertension, and morbid obesity. The study is vital as it can facilitate in guiding orthopedists and altering management for these high-risk patients.Level of evidenceLevel III, retrospective comparative study.