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Natalia Sadetsky, MD MPH, Urology Outcomes Research Group, UCSF, 3333 California st # 282, San Francisco, CA 94143, (415) 514-0693, natalia@uorg.ucsf.edu, Eric Elkin, MPH, Department of Urology, 3333 California st # 282, San Francisco, CA 94118, David M. Latini, PhD, Urology Dept., University of California, San Francisco, P. O. Box 1319, San Francisco, CA 94143-1319, and Peter Carroll, MD, UCSF, Department of Urology, 3333 California St # 282, San Francisco, CA 94118.
Introduction and objectives: With the changes occurring in the US healthcare system in the last two decades there been an increased concerns that rapid growth of the managed care industry may be limiting access to treatments for ill patients. In this study we will examine whether differences exist in prostate cancer treatment between patients enrolled in CaPSURE. Methods: CaPSURE™, a longitudinal observational database of men with prostate cancer, comprise of 10,018 patients and 40 study sites. Men who were newly diagnosed with localized disease and selected radical prostatectomy, external radiation, brachytherapy, hormonal therapy or surveillance were selected. Insurance status was defined as 5 categories: Medicare only, Medicare plus supplement, HMO, PPO, FFS, and VA only. 4491 men met the criteria. Odds ratios (OR) for the likelihood of receiving each type of therapy compared to RP by insurance status compared to Medicare were derived using multinomial logistic regression, adjusting for study site and other clinical and demographic variables. Results: Adjusted odds ratios demonstrated strong association of choice of treatment and insurance status. Patients in VA system were twice as likely to receive brachytherapy then radical prostatectomy (OR=2.44 CI 0.66, 8.94) with the patients in PPO category less likely to receive the same treatment (OR=0.57 CI 0.38, 0.86). Men in PPO and HMO category were less likely to receive hormonal therapy. Conclusion: Even when controlling for important clinical and sociodemographic factors likely to confound the relationship between health plans and outcomes we found marked differences in prostate cancer treatment practices according to type of health coverage.
Learning Objectives:
Keywords: Insurance, Cancer
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.