title: Comparison of urologist reimbursement for managing patients with low-risk prostate cancer by active surveillance versus total prostatectomy.
abstract: Active surveillance (AS) is an alternative to total prostatectomy (TP) in managing low-risk prostate cancer (PC). Our aim is to compare urologist reimbursement for managing low-risk PC by AS or TP. The urologist's reimbursement for TP includes the fee for the procedure and follow-up visits. For AS, our protocol involves digital rectal examination (DRE) and PSA testing every 3 months for first 2 years and every 6 months thereafter. Transrectal ultrasound (TRUS)-guided biopsies are performed yearly. Some urologists recommend spacing the biopsies by 1-3 years. Medicare reimbursement values were used. The urologist reimbursements for a follow-up visit, prostate biopsy, open TP and robotic TP are $72, $595, $1905 and $2939, respectively. We also corrected for a 15% chance of having TP after being on AS. The cumulative reimbursements from open TP and following the patient up to 10 years are approximately $2121 (1 year), $2265 (2 years), $2697 (5 years) and $3057 (10 years). For robotic TP, the urologist reimbursements are $3155 (1 year), $3259 (2 years), $3731 (5 years) and $4091 (10 years). For AS, the urologist reimbursements are $883 (1 year), $1766 (2 years), $4269 (5 years) and $7964 (10 years). The urologist reimbursement from AS and TP become nearly equal between 3 and 4 years follow-up, subsequently AS attains higher reimbursement.
authors.affiliation: Department of Urology, Miller School of Medicine, University of Miami, Miami, FL 33101, USA. mmanoharan@med.miami.edu
authors.forename: M
authors.initials: M
authors.lastname: Manoharan
authors.forename: A
authors.initials: A
authors.lastname: Eldefrawy
authors.forename: D
authors.initials: D
authors.lastname: Katkoori
authors.forename: E
authors.initials: E
authors.lastname: Antebi
authors.forename: M S
authors.initials: MS
authors.lastname: Soloway
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D002277:Carcinoma / Q000191:economics / Q000473:pathology / Q000628:therapy*; D003266:Continuity of Patient Care / Q000191:economics; D018588:Fee-for-Service Plans; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009819:Office Visits / Q000191:economics; D010818:Practice Patterns, Physicians' / Q000191:economics*; D011468:Prostatectomy / Q000191:economics* / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000191:economics / Q000473:pathology / Q000628:therapy*; D012307:Risk Factors; D012371:Robotics / Q000191:economics; D018571:Sentinel Surveillance; D014572:Urology / Q000191:economics* / Q000379:methods