Association of reimbursement policy and urologists' characteristics with the use of medical androgen deprivation therapy for clinically localized prostate cancer

Objectives: Physician characteristics and changes in drug reimbursement rates have been shown to influence practice patterns regardless of clinical guidelines, patient, clinical, or sociodemographic factors. We concurrently examined the association between urologists' characteristics and non evidence-based use of primary medical androgen deprivation therapy (ADT) for clinically localized patients with prostate cancer, before and after the 2003 Medicare Modernization Act's reductions in ADT reimbursement rates. Methods and materials: The Surveillance, Epidemiology, and End Results-Medicare linked database and the American Medical Association Physician Masterfile are used in a retrospective analysis of 12,255 patients diagnosed between 2001 and 2007 with clinical stage T1-T2, low- to intermediate-grade prostate cancer, and the 1,863 urologists who treated them. Logistic multilevel regression analyses are used to evaluate the association of urologists' characteristics on ADT use among patients within 6 months of diagnosis. Results: Overall, 3,866 (32%) patients received non evidence-based ADT. After adjusting for patient and urologist characteristics, patients treated by urologists with no medical school affiliations, compared with those treated by urologists with major medical school affiliations, are significantly more likely to receive non evidence-based medical ADT (odds ratio = 2.35; 95% CI: 1.71-3.23; P < 0.0001). Non US-trained urologists are also more likely to prescribe non evidence-based medical ADT (odds ratio = 1.64; 95% CI: 1.33-2.04; P < 0.0001). Conclusions: Patients treated by non medical school affiliated or non US-trained urologists or both are significantly more likely to receive non evidence-based ADT before and after the passage of the Medicare Modernization Act. Better strategies to encourage evidence-based ADT use on clinically localized patients with prostate cancer may be of benefit especially among non medical school affiliated or non US-trained urologists or both. (C) 2014 Elsevier Inc. All rights reserved.