Abstract B86: Health care utilization during transition to Medicare coverage in patients with prostate cancer: Evidence from CaPSURE registry
Authors: Sadetsky Natalia , Cooperberg Matthew , Braithwaite Dejana , Pasick Rena 
Published: December 2010

Introduction: While Medicare eligibility for all adults who reach 65 years of age provide universal insurance coverage, disparity in utilization of medical services still persists. The purpose of our study is to evaluate utilization of medical services and general health-related quality of life outcomes in patients with prostate cancer during their transition to the Medicare coverage. We hypothesize that transition to universal coverage, especially the one that provides expanded services will lead to increase in utilization of the medical services and improvements in quality of life.

Methods: Data from CaPSURE™ (Cancer of the Prostate Strategic Urological Research Endeavor), a longitudinal, observational registry of men with biopsy-proven prostate adenocarcinoma, was used for this study. Patients, who were diagnosed within 6 months of treatment, treated with Radical Prostatectomy (RP), External Beam Radiation (EBRT) and Brachytherapy (BT) and were younger than 65 at diagnosis were eligible for the study. In addition, participants had to have questionnaire assessments within 4 years (2 years before and 2 years after) of turning 65. Utilization of the medical services was measured by 1) total number of office visits; 2) number of visits related to prostate cancer care; 3) number of visits not related to prostate cancer care; 4) number of visits to physicians, 5) number of visits to non-physician health professionals, 6) total number of diagnostic tests, 7) number of diagnostic tests related to prostate cancer, and 8) number of diagnostic tests not related to prostate cancer. Change in insurance coverage was identified by No change in coverage, Change to Medicare only and change to Medicare plus supplement. Repeated measures analysis with mixed modeling was implemented to evaluate relationship between utilization of medical services, general HRQOL and transition in the insurance coverage overtime.

Results: 861 participants met study inclusion and exclusion criteria. Utilization of the medical services and general health related outcomes differed among participants in different categories of transition when evaluated by univariate analysis. Participants in Medicare+ group had higher number of total office visits, non-prostate cancer related visits, physician, and non-physician medical professional visits, and diagnostic tests compared to NC and Medicare groups. However, number of visits and diagnostic tests related to prostate cancer was not affected by insurance transition. In the multivariate analysis, transition to Medicare+ was associated with higher total and non-prostate cancer related diagnostic tests. Office visits utilization was higher in Medicare+ group but association did not retain statistical significance. Similar to univariate analysis utilization of the visits and diagnostic tests related to prostate cancer was not associated with changes in insurance coverage.

Conclusion: Our study demonstrated that in the population of men diagnosed with prostate cancer disparity in utilization of medical visits and use of diagnostic tests was associated with presence or absence of expanded Medicare coverage. This information provides an important insight on burden of health care expenditures in older adults with cancer.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B86.