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Clinical Research

Prostate cancer in the medicare shared savings program: are Accountable Care Organizations associated with reduced expenditures for men with prostate cancer?

Prostate Cancer and Prostatic Diseases volume 22, pages 593–599 (2019)Cite this article

Subjects

Abstract

Objectives

To assess whether Medicare expenditures for men with incident prostate cancer, treated in Accountable Care Organizations (ACOs) differ from those of men treated in non-ACOs.

Methods

Using the 20% Medicare sample, total charges for 1 year following an initial diagnosis of prostate cancer were abstracted from Medicare claims. Prostate cancer expenditures were calculated by subtracting total charges from the year prior to diagnosis. Propensity score weighting was used to balance baseline characteristics of men treated in ACOs and non-ACOs, and between treatment modalities (radiation, prostatectomy, and expectant management). A propensity score weighted regression model was then used to estimate mean expenditures for men with prostate cancer treated in ACOs and non ACOs and to test the association between ACO status and costs.

Results

We identified 3297 men treated in ACOs for localized prostate cancer versus 24,088 in the non-ACO cohort. The weighted total charges for each treatment modality were $32,358 (radiation), $27,662 (prostatectomy), and $11,134 (expectant management). In our propensity score weighted regression model, the association between charges and ACO status was not significant, nor was the interaction between treatment type and costs. This was true both overall, and in a stratified analysis by treatment type.

Conclusions

There was no significant difference in Medicare spending on prostate cancer care based on provider ACO affiliation, regardless of treatment type. Although the effects of ACOs on clinical care are complex, this study adds to a growing body of evidence suggesting that ACOs fail to achieve significantly lower charges in certain clinical settings.

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Acknowledgements

Q.-D.T. is supported by the Brigham Research Institute Fund to Sustain Research Excellence, the Bruce A. Beal and Robert L. Beal Surgical Fellowship, the Genentech Bio-Oncology Career Development Award from the Conquer Cancer Foundation of the American Society of Clinical Oncology (grant # 10202), a Health Services Research pilot test grant from the Defense Health Agency, the Clay Hamlin Young Investigator Award from the Prostate Cancer Foundation (grant # 16YOUN20), and an unrestricted educational grant from the Vattikuti Urology Institute.

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Authors and Affiliations

  1. Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Alexander P. Cole, Anna Krasnova, Ashwin Ramaswamy, David F. Friedlander, Sean A. Fletcher, Joel S. Weissman & Quoc-Dien Trinh

  2. Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Alexander P. Cole, David F. Friedlander, Sean A. Fletcher, Adam S. Kibel & Quoc-Dien Trinh

  3. Lank Center for Genitourinary Oncology, Brigham and Women’s/Dana Farber Cancer Center, Harvard Medical School, Boston, MA, USA

    Maxine Sun & Toni K. Choueiri

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  1. Alexander P. Cole
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Correspondence to Quoc-Dien Trinh.

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Conflict of interest

Q.-D.T. reports honoraria from Astellas, Bayer, and Jannseen and research funding from Bayer and Intuitive Surgical. A.S.K. reports consulting fees from Profound, Janssen, and ConfirmMDX. T.K.C. has received research funding from Pfizer and has an advisory role at Pfizer, Novartis, GlaxoSmithKline, Genentech, and Bayer. The remaining authors declare that they have no conflict of interest.

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Cole, A.P., Krasnova, A., Ramaswamy, A. et al. Prostate cancer in the medicare shared savings program: are Accountable Care Organizations associated with reduced expenditures for men with prostate cancer?. Prostate Cancer Prostatic Dis 22, 593–599 (2019). https://doi.org/10.1038/s41391-019-0138-1

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