Prostate imaging dictated by policy, not indication
MedWire News: Geographic regions with high rates of imaging for prostate cancer tend to have increased rates of both appropriate and inappropriate imaging, the results from a US study suggest.
For example, men with high-risk prostate cancer are more likely to undergo guideline-appropriate imaging if they live in areas with higher rates of inappropriate testing, report investigators.
"This analysis suggests that efforts to lower inappropriate use of imaging may simultaneously lower appropriate use of imaging because the two appear to be coupled," say Danil Makarov (New York University School of Medicine) and colleagues.
With a growing pressure to reduce the cost of medicine, US policy-makers often seek to reduce healthcare expenditures in high-use regions. However, the "thermostat model" suggests that each region might be predisposed to using resources that affect the use of both appropriate and inappropriate testing.
In the present study, published in Health Affairs, the researchers determined whether appropriate and inappropriate imaging for prostate cancer, including computed tomography (CT), magnetic resonance imaging (MRI), and radionuclide bone scans, were associated with the overall frequency of ordering the imaging tests.
In total, 18,491 men with low-risk prostate cancer and 10,562 men with high-risk prostate cancer were identified from Medicare databases.
Appropriate imaging was based on the 2002 guidelines of the National Comprehensive Cancer Network and was defined as prostate cancer staging imaging for patients at high risk for metastatic spread, such as those with evident, observable, or tangible cancer.
Overall, more than 45% of men with low-risk prostate cancer underwent guideline-inappropriate imaging and only two-thirds of men with high-risk disease had appropriate scans.
The unadjusted rate of inappropriate imaging among men with low-risk prostate cancer ranged from 24% in Utah to 65% in New Jersey. By contrast, the rates of appropriate imaging for men with high-risk disease ranged from 50% in Georgia to 79% in the Utah registry.
The percentage of high-risk men receiving appropriate imaging scans increased as overall imaging frequency increased. Similarly, inappropriate imaging among low-risk patients also increased as overall regional imaging rates increased.
"Imaging use appears to be determined strongly by regional practice patterns and affinity for imaging, rather than by medical indication," observe Makarov and colleagues.
Future efforts to control healthcare costs can't be a "one size fits all" approach, according to the researchers, but instead must be multifaceted to carefully ensure that cutting inappropriate use of healthcare resources does not compromise the utilization of appropriate care.
By MedWire Reporters