To assess the impact of the Modernization Act, Shahinian and his colleagues looked at records of almost 55,000 men diagnosed with prostate cancer between 2003 and 2005. Patients were separated out based on the characteristics of their tumors -- for example, localized vs. locally advanced, and whether evidence existed to support use of this therapy in those cases. An intermediate category was established for cases where the decision was less clear-cut.
Unnecessary use of androgen-deprivation therapy declined from 38.7 percent in 2003 to 30.6 percent in 2004, then to 25.7 percent in 2005, the study authors reported.
But there were no changes in appropriate use of the therapy, which stayed stable, the researchers said. Meanwhile, gray-zone use declined in 2005, but not the prior year.
Research identifying some adverse effects of hormonal therapy may also have contributed to the reduction, the authors said.
Whether these findings -- or whether similar reimbursement changes in other areas -- will affect the U.S. health-care system isn't clear, especially with the current push towards personalized medicine.
"It's very subjective. There are no hard-core guidelines. There are suggestions," Moul said. "In general, you want to use hormone therapy in higher-risk men who have worse disease but there's a fairly significant gray zone," he pointed out.
"There's probably many, many areas where the system could be tightened up, where we could save money but the downside is going to be a lot of individual patients who are going to be mad because they can't get what they want to get," he added.
Shahinian is a consultant for the biotechnology firm Amgen. The American Cancer Society funded this study.
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