High Medicare Spending on Prostate Cancer Screenings, But Little Benefit For Older Men

Prostate cancer screening has little benefit for men aged 75 and
older, yet over three years, the Medicare fee-for-service program spent $447
million annually on PSA-based screenings — one-third of which was for men in
the over 75 age group, according to study by researchers at the Yale Cancer
Outcomes, Public Policy, and Effectiveness Research (COPPER) Center. Published
in the Oct. 4 issue of the journal Cancer,
the study also found considerable geographic variation in the cost of prostate
cancer screening. Many prostate cancers are slow-growing and unlikely to become
problematic. Widespread screening with a serum-based PSA test may result in
unnecessary invasive biopsies, which can be a physical burden or even harmful.
In 2012, the U.S. Preventative Services Task Force decided to stop recommending
PSA screening for men of any age. Medicare, however, continues to reimburse for
this test and the subsequent procedures. Lead author Xiaomei Ma, Associate
Professor at Yale School of Public Health, and her Yale COPPER Center
colleagues conducted an observational study of older male Medicare
beneficiaries who were free of prostate cancer and other lower urinary tract
symptoms at the end of 2006, and followed them for three years. In addition to
large Medicare spending for prostate cancer screening in older men, the team
found that the costs of prostate cancer screening ranged considerably from $17
to $62 per beneficiary across regions. The bulk of this variation was not due
to the cost of PSA test itself, but rather to variation in costs of the
follow-up tests across regions. “More than 70 percent of prostate cancer
screening-related costs were due to follow-up procedures,” said Ma, who is also
a member of the Yale Cancer Center. “Our results suggest that the overall cost
of prostate cancer screening may be heavily influenced by how urologists choose
to respond to the result of a PSA test, more so than the use of the PSA
itself.” Meanwhile, the benefits of screening and treatment are not clear.
While men living in high-spending regions were more likely to be diagnosed with
localized cancers, they were not significantly less likely to be diagnosed with
metastatic cancer. This suggests that spending more on prostate cancer
screening might identify more localized tumors, but may not necessarily reduce
the rate of metastatic cancers.

Source/more: EurekAlert