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Study shows drop in unnecessary care after Medicare reimbursement cut
Date:11/3/2010

edicare Modernization Act of 2003 changed policies for reimbursement of injected medications, including hormonal therapy, eventually setting it at 106 percent of the average sale price by 2005. This number was more precise than the wholesale price, as it was based on actual sales transactions reported by the pharmaceutical companies, leaving less room for profit.

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, a large population-based registry.

"SEER-Medicare has all the detailed cancer and treatment data we needed to categorize these patients, and it gave us a very good picture of the response to this change in Medicare reimbursement," said study author Yong-Fang Kuo, an associate professor at the University of Texas Medical Branch at Galveston.

Scott M. Gilbert, M.D., M.S., assistant professor of urology at the University of Florida College of Medicine, was also a co-author.

Patients were separated into three categories for androgen deprivation therapy 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 androgen deprivation therapy stayed steady for patients in the appropriate use category. Inappropriate use, however, dropped from 39 percent at the end of 2003 to 22 percent 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.

"There's a growing realization that these treatments might have more side effects than we first realized," Shahinian says. "Some of the patients who had been receiving androgen deprivation therapy would tend to do
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Contact: Nicole Fawcett
nfawcett@umich.edu
734-764-2220
University of Michigan Health System
Source:Eurekalert

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