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High Medicare Spending on Prostate Cancer Screenings, But Little Benefit for Older Men

Yale study finds wide variation in screening costs (October 4)

Prostate cancer screening has little benefit for men aged 75 years and older, and yet over 3 years, the Medicare fee-for-service program spent $447 million annually on prostate-specific antigen (PSA)-based screenings — one-third of which was for men in the over-75 age group, according to a study by Yale University researchers.

Published in the Oct. 4 issue of Cancer, the study also found considerable geographic variation in the cost of prostate cancer screening.

Lead author Xiao-mei Ma and her colleagues conducted an observational study of older male Medicare beneficiaries who were free of prostate cancer and other lower urinary tract symptoms at the end of 2006, and followed them for 3 years.

In addition to large Medicare spending for prostate cancer screening in older men, the researchers found that the costs of prostate cancer screening ranged considerably across regions, from $17 to $62 per beneficiary. The bulk of this variation was not due to the cost of the PSA test itself, but rather to variation in costs of the follow-up tests across regions, the authors found.

“More than 70% of prostate cancer screening-related costs were due to follow-up procedures,” said Ma. “Our results suggest that the overall cost of prostate cancer screening may be heavily influenced by how urologists choose to respond to the result of a PSA test, more so than the use of the PSA itself.”

Meanwhile, the benefits of screening and treatment are not clear. While men living in high-spending regions were more likely to be diagnosed with localized cancers, they were not significantly less likely to be diagnosed with metastatic cancer. This suggests that spending more on prostate cancer screening might identify more localized tumors, but may not necessarily reduce the rate of metastatic cancers.

“In a time when health care spending is soaring, it is important to weigh the physical, psychological, and financial burden of cancer screening against the possible clinical benefit,” said Dr. Gary Gross, professor of internal medicine at the Yale School of Medicine. “The cancer research community needs to continue exploring novel approaches to target prostate cancer screening and treatment efforts, identifying and disseminating strategies that work, and abandoning strategies that don’t work.”

Source: Yale University; October 4, 2013.

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