EPIDEMIOLOGIC TRENDS AND FINANCIAL OUTCOMES IN RADICAL PROSTATECTOMY AMONG MEDICARE BENEFICIARIES, 1991 TO 1993

Purpose: We define epidemiological trends in radical prostatectomy amo ng Medicare beneficiaries in the United States, describe related finan cial reimbursement to hospitals and physicians, and determine how many men received adjuvant therapy with androgen ablation or pelvic irradi ation from 1991 to 1993. Materials and Methods: We examined radical pr ostatectomy claims from a national 5% simple random sample (688,000 me n) of 1991, 1992 and 1993 data on Medicare beneficiaries from the Heal th Care Financing Administration. We determined rates of radical prost atectomies among patients stratified by age, race and geographical reg ion, and measured the fraction of men who had claims submitted for pos toperative 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 bene ficiaries 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 stu dy period. Geographical variations greater than 2-fold were noted. Tot al Medicare expenditures for radical prostatectomy were $194.2 million in 1991, $277.8 million in 1992 and $230,8 million in 1993. During 19 91 to 1993 hospitals received more than three-fourths of total Medicar e payments for radical prostatectomy, while physicians received less t han one-fourth. More than 23% of men undergoing radical prostatectomy received subsequent therapy with gonadotropin releasing hormone agonis ts, 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 app ear to be as definitively curative as expected.