title: Certificate of need legislation and the dissemination of robotic surgery for prostate cancer.
abstract: OBJECTIVE
  The uncertainty about the incremental benefit of robotic prostatectomy and its higher associated costs makes it an ideal target for state based certificate of need laws, which have been enacted in several states. We studied the relationship between certificate of need laws and market level adoption of robotic prostatectomy.
  
  
  METHODS
  We used SEER (Surveillance, Epidemiology, and End Results)-Medicare data from 2003 through 2007 to identify men 66 years old or older treated with prostatectomy for prostate cancer. Using data from the American Health Planning Association, we categorized Health Service Areas according to the stringency of certificate of need regulations (ie low vs high stringency) presiding over that market. We assessed our outcomes (probability of adopting robotic prostatectomy and propensity for robotic prostatectomy use in adopting Health Service Areas) using Cox proportional hazards and Poisson regression models, respectively.
  
  
  RESULTS
  Compared to low stringency markets, high stringency markets were more racially diverse (54% vs 15% nonwhite, p <0.01), and had similar population densities (886 vs 861 people per square mile, p = 0.97) and median incomes ($42,344 vs $39,770, p = 0.56). In general, both market types had an increase in the adoption and utilization of robotic prostatectomy. However, the probability of robotic prostatectomy adoption (p = 0.22) did not differ based on a market's certificate of need stringency and use was lower in high stringency markets (p <0.01).
  
  
  CONCLUSIONS
  State based certificate of need regulations were ineffective in constraining robotic surgery adoption. Despite decreased use in high stringency markets, similar adoption rates suggest that other factors impact the diffusion of robotic prostatectomy.
authors.affiliation: Department of Urology, Division of Oncology, University of Michigan, Ann Arbor, Michigan 48109-2800, USA.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Jacobs
authors.forename: Yun
authors.initials: Y
authors.lastname: Zhang
authors.forename: Ted A
authors.initials: TA
authors.lastname: Skolarus
authors.forename: John T
authors.initials: JT
authors.lastname: Wei
authors.forename: James E
authors.initials: JE
authors.lastname: Montie
authors.forename: Florian R
authors.initials: FR
authors.lastname: Schroeck
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
mesh_terms: D000368:Aged; D002567:Certificate of Need / Q000331:legislation & jurisprudence*; D004059:Diffusion of Innovation; D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012371:Robotics / Q000706:statistics & numerical data*