title: Androgen deprivation falls as orchiectomy rates rise after changes in reimbursement in the U.S. Medicare population.
abstract: BACKGROUND
  Expenditures related to the use of medical androgen deprivation led in part to the Medicare Modernization Act (MMA) in 2003. This mandated a decline in reimbursement to 80% to 85% of the average wholesale price starting in 2004 followed by a more significant reduction in 2005 to 106% of the average sales price, which effectively reduced the reimbursement by approximately 50% of 2003 values. The authors hypothesized that these changes in reimbursement may affect the way practitioners administer these treatments.
  
  
  METHODS
  The publicly available dataset Medicare Part B Extract Summary System was examined from 2001 to 2005 for trends in the number of allowed services and dollar amounts of allowed charges and payments. The reimbursable Medicare codes of J9217 (leuprolide acetate), J9202 (goserelin acetate), J9219 (leuprolide acetate implant), and J3315 (triptorelin pamoate) were examined for medical castration. The code for simple orchiectomy, 54520, was used for surgical castration.
  
  
  RESULTS
  The use of medical castration increased from 2001 to 2003, whereas, over the same period, surgical castration decreased. Total allowed charges for medical castration peaked in 2003 at $1.23 billion. After the enactment of the MMA, surgical castration rates increased, and medical castration decreased. Total allowed charges for medical castration in 2005 dropped 65% from the 2003 peak.
  
  
  CONCLUSIONS
  The use of medical androgen ablation decreased significantly with the decrease in reimbursement. The administration of either surgical or medical castration in the U.S. Medicare population appears to be tied closely to reimbursement in trend, but not always in magnitude.
authors.affiliation: Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Weight
authors.forename: Eric A
authors.initials: EA
authors.lastname: Klein
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Jones
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000191:economics / Q000627:therapeutic use*; D004363:Drug Utilization / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000191:economics; D017048:Health Care Costs; D006302:Health Services Research; D006801:Humans; D008297:Male; D016345:Medicare Part B / Q000706:statistics & numerical data; D009919:Orchiectomy / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D010818:Practice Patterns, Physicians'; D011471:Prostatic Neoplasms / Q000191:economics / Q000628:therapy*; D012051:Reimbursement Mechanisms; D014481:United States
chemical_list: D018931:Antineoplastic Agents, Hormonal; D007987:Gonadotropin-Releasing Hormone