Epidemiological trends and financial outcomes in radical prostatectomy among Medicare beneficiaries, 1991 to 1993
Epidemiological trends and financial outcomes in radical prostatectomy among Medicare beneficiaries, 1991 to 1993
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DOI：
10.1016/s0022-5347(01)62921-5
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发表时间：
1998-08-01
影响因子：
6.6
通讯作者：
Carroll, PR
中科院分区：
文献类型：
--
作者：
Litwin, MS;Pasta, DJ;Carroll, PR
目的：我们定义了美国联邦医疗保险受益人中前列腺癌根治术的流行趋势，描述了医院和医生的相关经济补偿，并确定了从1991年到1993年，有多少男性接受了雄激素消融或盆腔放射辅助治疗。材料和方法：我们从1991年、1992年和1993年的全国5%简单随机样本(68.8万名男性)中检验了根治性前列腺切除术的索赔，这些数据来自医疗保健融资管理局关于联邦医疗保险受益人的数据。我们确定了按年龄、种族和地理区域分层的患者中根治性前列腺切除术的比率，并测量了提交前列腺癌术后治疗申请的男性比例。我们还收集了联邦医疗保险A部分和B部分的财务信息，以估计联邦政府在这一人群中根治性前列腺切除术的经济负担。结果：在1991年至1993年期间符合联邦医疗保险要求的5,016名患者中，前列腺癌根治术的比率在1992年达到峰值，每10万名男性中有284人，第二年下降。对于最年轻的联邦医疗保险受益人，这一比率从1991年到1992年增加了233%，从1992年到1993年增加了156%。在所有三年中，白人男性的这一比例都高于非白人男性，但只有非白人男性的这一比例在研究期间持续上升。注意到地理差异超过2倍。用于根治性前列腺切除术的医疗保险总支出1991年为1.942亿美元，1992年为2.778亿美元，1993年为2.308亿美元。从1991年到1993年，医院收到了超过四分之三的医疗保险付款，用于根治性前列腺切除术，而医生收到的不到四分之一。超过23%的接受根治性前列腺切除术的男性在根治性前列腺癌切除术后3年内接受了促性腺激素释放激素激动剂、双侧切除术和/或盆腔放射治疗。结论：根治性前列腺癌切除术是联邦医疗保健资金的重要负担，似乎并不像预期的那样有明确的疗效。
Purpose: We define epidemiological trends in radical prostatectomy among Medicare beneficiaries in the United States, describe related financial reimbursement to hospitals and physicians, and determine how many men received adjuvant therapy with androgen ablation or pelvic irradiation from 1991 to 1993.Materials and Methods: We examined radical prostatectomy claims from a national 5% simple random sample (688,000 men) of 1991, 1992 and 1993 data on Medicare beneficiaries from the Health Care Financing Administration. We determined rates of radical prostatectomies among patients stratified by age, race and geographical region, and measured the fraction of men who had claims submitted for postoperative therapies for prostate cancer. We also collected financial information for Medicare parts A and B to estimate federal government economic burden from radical prostatectomy in this population.Results: Among the 5,016 patients identified with Medicare claims for radical prostatectomy during 1991 to 1993 the rate peaked at 284/100,000 men in 1992 before declining the next year. For the youngest Medicare beneficiaries the rate increased 233% from 1991 to 1992 and 156% from 1992 to 1993. White men had a higher rate than nonwhite men in all 3 years but only in nonwhite men did the rate continue to rise during the study period. Geographical variations greater than 2-fold were noted. Total Medicare expenditures for radical prostatectomy were $194.2 million in 1991, $277.8 million in 1992 and $230,8 million in 1993. During 1991 to 1993 hospitals received more than three-fourths of total Medicare payments for radical prostatectomy, while physicians received less than one-fourth. More than 23% of men undergoing radical prostatectomy received subsequent therapy with gonadotropin releasing hormone agonists, bilateral orchiectomy and/or pelvic irradiation within 3 years of radical prostatectomy.Conclusions: Radical prostatectomy represents a significant burden on the federal health care dollar and does not appear to be as definitively curative as expected.