NEW YORK (Reuters Health) - The use of hormone treatment for prostate cancer has declined, offset only in part by increases in surgical testicle removal, since Medicare reduced reimbursement for administration of these drugs that block testosterone starting in 2004.
"Although correlation does not prove causation, these data contain a clear trend," suggesting the decrease in number of prescriptions written for anti-testosterone drugs by practitioners who treat Medicare patients is most likely the result of financial pressures, physicians at the Cleveland Clinic in Ohio report in the journal Cancer.
Testosterone and related "androgen" hormones stimulate the growth of prostate cancers. By taking out the major testosterone source, testicle removal achieves the same effect as anti-testosterone drugs, but most men prefer the drugs to surgery, Dr. J. Stephen Jones and his associates note.
To determine trends in services and Medicare reimbursement, Jones' group examined the Medicare Part B Extract Summary System from 2001 to 2005.
They report that in 2005 the total allowed charge for anti-testosterone drugs, also referred to as medical castration, had dropped 64 percent from the peak in 2003 prior to the Medical Modernization Act, whereas the average payment for surgical castration had increased 7 percent.
During this same period, there was a 14 percent decline in the use of anti-testosterone drugs and a 4.2 percent increase in the number of testicle removals or "orchectomies." A review of medical literature showed "no pattern...that could explain such drastic changes in use beginning in 2004."
Therefore, Jones and his associates suggest, "variables other than evidence-based medicine and patient preference may influence treatment decisions significantly."
"The most plausible explanation of the change in practice is the change in reimbursement," they conclude.
These findings are not without clinical ramifications, the researchers note, because there are likely to be patients who would benefit from anti-testosterone agents for whom treatment would be withheld because of financial pressures.
In a related editorial, Dr. Gerald W. Chodak of the Midwest Prostate and Urology Health Center in Chicago notes that while changing a treatment recommendation solely for economic reasons is unethical, physicians cannot be expected to take a financial loss for practicing medicine.
He recommends that physicians be completely honest with patients, making sure they are aware of the choices and the factors affecting a particular recommendation.
SOURCE: Cancer, May 15, 2008 (online April 7, 2008.)
