Ewan K Cobran1, Henry N Young2, Ronald C Chen3, Xianyan Chen4, Jaxk Reeves4, Paul A Godley5, Surbhi Shah6. 1. University of Georgia, College of Pharmacy, Department of Clinical and Administrative Pharmacy, Division of Pharmaceutical Health Services, Outcomes, and Policy, Robert C. Wilson Pharmacy 250 West Green Street, 270B, Athens, GA 30602, USA. Electronic address: ecobran@uga.edu. 2. University of Georgia, College of Pharmacy, Department of Clinical and Administrative Pharmacy, Division of Pharmaceutical Health Services, Outcomes, and Policy, Robert C. Wilson Pharmacy 250 West Green Street, 270J, Athens, GA 30602, USA. 3. University of North Carolina at Chapel Hill, School of Medicine, Department of Radiation Oncology and Urology, 101 Manning Drive, Chapel Hill, NC 27514, USA. 4. University of Georgia, Franklin College of Arts and Sciences, Department of Statistics, Statistical Consulting Center, 310 Herty Drive, Athens, GA 30602, USA. 5. University of North Carolina at Chapel Hill, School of Medicine, Department of Hematology and Oncology, 4064 Bondurant Hall, Chapel Hill, NC 27514, USA. 6. Evidera, Real-World Evidence, 500 Totten Pond Road, Waltham, MA 02451, USA.
Abstract
BACKGROUND: The Medicare Modernization Act (MMA) drastically reduced reimbursement for androgen deprivation therapy (ADT) in 2005. One unintended consequence of the MMA may be an increase in the racial disparities in receipt of ADT. Given these policy changes, it becomes increasingly important to assess racial disparities in timely receipt of ADT. METHODS: The purpose of this study is to evaluate the associations between race and median time to receipt of ADT among men with metastatic prostate cancer before and after the passage of the MMA. A population-based retrospective cohort was created from the Surveillance, Epidemiology, and End Results-Medicare. RESULTS: A total of 1,846 African-American and 9,462 Caucasian men diagnosed with metastatic prostate cancer from 2000 through 2011 were included. An accelerated failure time regression model was used to examine factors associated with racial differences in median time to receipt of ADT. Results indicate that African-American men had a longer median time to receipt of ADT both before the MMA (Time Ratio (TR): 1.15; 95% Confidence Interval (CI) [1.05, 1.27]) and after the MMA (TR: 1.29; 95% CI [1.10, 1.53]) as compared to Caucasian men. In addition to race, men residing in South had longer median time to receipt of ADT (TR: 1.26, 1.52; 95% CI [1.01, 1.52; 1.24, 1.87] before and after MMA, respectively) compared to the Northeast region. CONCLUSION: Considering the palliative benefits of ADT, it is important to develop effective strategies to address racial differences in receipt of treatment for metastatic prostate cancer.
BACKGROUND: The Medicare Modernization Act (MMA) drastically reduced reimbursement for androgen deprivation therapy (ADT) in 2005. One unintended consequence of the MMA may be an increase in the racial disparities in receipt of ADT. Given these policy changes, it becomes increasingly important to assess racial disparities in timely receipt of ADT. METHODS: The purpose of this study is to evaluate the associations between race and median time to receipt of ADT among men with metastatic prostate cancer before and after the passage of the MMA. A population-based retrospective cohort was created from the Surveillance, Epidemiology, and End Results-Medicare. RESULTS: A total of 1,846 African-American and 9,462 Caucasian men diagnosed with metastatic prostate cancer from 2000 through 2011 were included. An accelerated failure time regression model was used to examine factors associated with racial differences in median time to receipt of ADT. Results indicate that African-American men had a longer median time to receipt of ADT both before the MMA (Time Ratio (TR): 1.15; 95% Confidence Interval (CI) [1.05, 1.27]) and after the MMA (TR: 1.29; 95% CI [1.10, 1.53]) as compared to Caucasian men. In addition to race, men residing in South had longer median time to receipt of ADT (TR: 1.26, 1.52; 95% CI [1.01, 1.52; 1.24, 1.87] before and after MMA, respectively) compared to the Northeast region. CONCLUSION: Considering the palliative benefits of ADT, it is important to develop effective strategies to address racial differences in receipt of treatment for metastatic prostate cancer.