title: Reimbursement cuts and changes in urologist use of androgen deprivation therapy for prostate cancer.
abstract: BACKGROUND
  We examined the impact of urologist academic affiliation on use of androgen deprivation therapy (ADT) for prostate cancer before and after major reimbursement cuts for ADT in hopes of better understanding the influence of financial incentives on its use. In particular, we hypothesized that if financial incentive was the predominant factor driving use, we should see a narrowing in the previously documented gap of ADT use between non-academic and academic urologists following the reimbursement cuts.
  
  
  METHODS
  With the Surveillance, Epidemiology and End-Results (SEER)-Medicare linked database we examined use of ADT for potentially inappropriate indications (primary therapy of localized, lower risk tumors) among patients of 2214 urologists over the period 2000-2002 and 2004-2007, representing eras before and after reimbursement cuts. Multi-level logistic regression models were used to estimate the likelihood of ADT use adjusted for patient, tumor and urologist characteristics (academic affiliation, board certification, years in practice and patient panel size).
  
  
  RESULTS
  Overall, ADT use peaked in 2002 at 46.6% of patients, but dropped dramatically in 2005, with a slow continued decrease through 2007 to 31.1%. A similar pattern was evident within most strata of urologist characteristics, including academic affiliation. In the multilevel model, patients of non-academic urologists had a 30% higher odds of receiving ADT than those of academic urologists in both the eras before and after the reimbursement cuts.
  
  
  CONCLUSIONS
  A similar proportionate drop in use of ADT among both academic and non-academic urologists following reimbursement cuts suggests that factors other than financial incentives may have played a role.
authors.affiliation: Department of Internal Medicine, University of Michigan, 1415 Washington Heights, Room 3627, SPH I, Ann Arbor, MI, 48109-2029, USA. vahakn@umich.edu.
authors.forename: Vahakn B
authors.initials: VB
authors.lastname: Shahinian
authors.affiliation: Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA. yokuo@utmb.edu.|Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA. yokuo@utmb.edu.|Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA. yokuo@utmb.edu.
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000639:trends; D000368:Aged; D000726:Androgen Antagonists / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics* / Q000639:trends; D008297:Male; D006278:Medicare / Q000191:economics / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D015995:Prevalence; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014572:Urology / Q000191:economics* / Q000639:trends
chemical_list: D000726:Androgen Antagonists