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Medicare Act Tied to Reductions in Inappropriate ADT Use

Use of androgen-deprivation therapy for non-evidence-based indications fell from 2003 to 2005

WEDNESDAY, Nov. 3 (HealthDay News) -- Implementation of the Medicare Modernization Act, which led to reduced reimbursement for androgen-deprivation therapy (ADT) for prostate cancer, appears to have substantially reduced the rate at which the therapy is used for inappropriate indications, according to research published in the Nov. 4 issue of the New England Journal of Medicine.

Vahakn B. Shahinian, M.D., of the University of Michigan in Ann Arbor, and colleagues evaluated data on 54,925 men diagnosed with prostate cancer between 2003 and 2005 to see whether Medicare reductions in reimbursement for ADT had resulted in a decrease of use of the therapy for non-evidence-based purposes.

The researchers found that the rate of inappropriate ADT use (i.e., as a primary therapy for men with localized, low-to-moderate grade cancers, for whom a survival benefit of the therapy was unlikely) declined from 38.7 percent in 2003 to 25.7 percent in 2005. There was also a decline in 2005 of discretionary use for men receiving primary or adjuvant therapy for localized, high-grade tumors, though not in 2004.

"Our results show a gradient, with the greatest drop in ADT use in the context of greatest uncertainty about efficacy and no drop in use where benefits are clearest, findings that are consistent with the hypothesis that financial incentives may be driving the observed trends," the authors write.

Shahinian disclosed a consulting relationship with Amgen, the manufacturer of denosumab, which is used for reduction of fracture risk with androgen deprivation.

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