Hansoo Ko1, Sherry A Glied2. 1. New York University Robert F. Wagner Graduate School of Public Service, New York, NY, USA. hansooko@nyu.edu. 2. New York University Robert F. Wagner Graduate School of Public Service, New York, NY, USA.
Abstract
BACKGROUND: Robotic prostatectomy is a costly new technology, but the costs may be offset by changes in treatment patterns. The net effect of this technology on Medicaid spending has not been assessed. OBJECTIVE: To identify the association of the local availability of robotic surgical technology with choice of initial treatment for prostate cancer and total prostate cancer-related treatment costs. DESIGN AND PARTICIPANTS: This cohort study used New York State Medicaid data to examine the experience of 9564 Medicaid beneficiaries 40-64 years old who received a prostate biopsy between 2008 and 2017 and were diagnosed with prostate cancer. The local availability of robotic surgical technology was measured as distance from zip code centroids of patient's residence to the nearest hospital with a robot and the annual number of robotic prostatectomies performed in the Hospital Referral Region. MAIN MEASURES: Multivariate linear models were used to relate regional access to robots to the choice of initial therapy and prostate cancer treatment costs during the year after diagnosis. KEY RESULTS: The mean age of the sample of 9564 men was 58 years; 30% of the sample were White, 26% were Black, and 22% were Hispanic. Doubling the distance to the nearest hospital with a robot was associated with a reduction in robotic surgery rates of 3.7 percentage points and an increase in the rate of use of radiation therapy of 5.2 percentage points. Increasing the annual number of robotic surgeries performed in a region by 10 was associated with a decrease in the probability of undergoing radiation therapy of 0.6 percentage point and a $434 reduction in total prostate cancer-related costs per Medicaid patient. CONCLUSIONS: A full accounting of the costs of a new technology will depend on when it is used and the payment rate for its use relative to payment rates for substitutes.
BACKGROUND: Robotic prostatectomy is a costly new technology, but the costs may be offset by changes in treatment patterns. The net effect of this technology on Medicaid spending has not been assessed. OBJECTIVE: To identify the association of the local availability of robotic surgical technology with choice of initial treatment for prostate cancer and total prostate cancer-related treatment costs. DESIGN AND PARTICIPANTS: This cohort study used New York State Medicaid data to examine the experience of 9564 Medicaid beneficiaries 40-64 years old who received a prostate biopsy between 2008 and 2017 and were diagnosed with prostate cancer. The local availability of robotic surgical technology was measured as distance from zip code centroids of patient's residence to the nearest hospital with a robot and the annual number of robotic prostatectomies performed in the Hospital Referral Region. MAIN MEASURES: Multivariate linear models were used to relate regional access to robots to the choice of initial therapy and prostate cancer treatment costs during the year after diagnosis. KEY RESULTS: The mean age of the sample of 9564 men was 58 years; 30% of the sample were White, 26% were Black, and 22% were Hispanic. Doubling the distance to the nearest hospital with a robot was associated with a reduction in robotic surgery rates of 3.7 percentage points and an increase in the rate of use of radiation therapy of 5.2 percentage points. Increasing the annual number of robotic surgeries performed in a region by 10 was associated with a decrease in the probability of undergoing radiation therapy of 0.6 percentage point and a $434 reduction in total prostate cancer-related costs per Medicaid patient. CONCLUSIONS: A full accounting of the costs of a new technology will depend on when it is used and the payment rate for its use relative to payment rates for substitutes.
Authors: Paolo Dell'oglio; Anne Sophie Valiquette; Sami-Ramzi Leyh-Bannurah; Zhe Tian; Vincent Trudeau; Alessandro Larcher; Shahrokh F Shariat; Umberto Capitanio; Alberto Briganti; Markus Graefen; Francesco Montorsi; Pierre I Karakiewicz Journal: Can Urol Assoc J Date: 2018-03-19 Impact factor: 1.862
Authors: Colette J Shen; Chen Hu; Matthew M Ladra; Amol K Narang; Craig E Pollack; Stephanie A Terezakis Journal: Cancer Date: 2017-06-27 Impact factor: 6.860
Authors: William T Lowrance; James A Eastham; Caroline Savage; A C Maschino; Vincent P Laudone; Christopher B Dechet; Robert A Stephenson; Peter T Scardino; Jaspreet S Sandhu Journal: J Urol Date: 2012-04-11 Impact factor: 7.450
Authors: Christian Bolenz; Amit Gupta; Timothy Hotze; Richard Ho; Jeffrey A Cadeddu; Claus G Roehrborn; Yair Lotan Journal: Eur Urol Date: 2009-11-11 Impact factor: 20.096
Authors: Anuradha R Bhama; Abdullah M Wafa; Jane Ferraro; Stacey D Collins; Andrew J Mullard; James F Vandewarker; Greta Krapohl; John C Byrn; Robert K Cleary Journal: J Gastrointest Surg Date: 2016-02-03 Impact factor: 3.452
Authors: Junaid Nabi; David F Friedlander; Xi Chen; Alexander P Cole; Jim C Hu; Adam S Kibel; Prokar Dasgupta; Quoc-Dien Trinh Journal: JAMA Netw Open Date: 2020-01-03