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Use of bone scan during initial prostate cancer workup, downstream procedures, and associated Medicare costs.

ABSTRACT: For patients with a high likelihood of having metastatic disease (high-risk prostate cancer), bone scan is the standard, guideline-recommended test to look for bony metastasis. We quantified the use of bone scans and downstream procedures, along with associated costs, in patients with high-risk prostate cancer, and their use in low- and intermediate-risk patients for whom these tests are not recommended.Patients in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database diagnosed with prostate cancer from 2004 to 2007 were included. Prostate specific antigen (PSA), Gleason score, and clinical T stage were used to define D'Amico risk categories. We report use of bone scans from the date of diagnosis to the earlier of treatment or 6 months. In patients who underwent bone scans, we report use of bone-specific x-ray, computed tomography (CT), and magnetic resonance imaging (MRI) scans, and bone biopsy within 3 months after bone scan. Costs were estimated using 2012 Medicare reimbursement rates.In all, 31% and 48% of patients with apparent low- and intermediate-risk prostate cancer underwent a bone scan; of these patients, 21% underwent subsequent x-rays, 7% CT, and 3% MRI scans. Bone biopsies were uncommon. Overall, <1% of low- and intermediate-risk patients were found to have metastatic disease. The annual estimated Medicare cost for bone scans and downstream procedures was $11,300,000 for low- and intermediate-risk patients. For patients with apparent high-risk disease, only 62% received a bone scan, of whom 14% were found to have metastasis.There is overuse of bone scans in patients with low- and intermediate-risk prostate cancers, which is unlikely to yield clinically actionable information and results in a potential Medicare waste. However, there is underuse of bone scans in high-risk patients for whom metastasis is likely.

SUBMITTER: Falchook AD

PROVIDER: S-EPMC5842944 | biostudies-literature | 2014 Jun

REPOSITORIES: biostudies-literature

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Use of bone scan during initial prostate cancer workup, downstream procedures, and associated Medicare costs.

Falchook Aaron D AD Salloum Ramzi G RG Hendrix Laura H LH Chen Ronald C RC

International journal of radiation oncology, biology, physics 20131207 2

<h4>Purpose</h4>For patients with a high likelihood of having metastatic disease (high-risk prostate cancer), bone scan is the standard, guideline-recommended test to look for bony metastasis. We quantified the use of bone scans and downstream procedures, along with associated costs, in patients with high-risk prostate cancer, and their use in low- and intermediate-risk patients for whom these tests are not recommended.<h4>Methods and materials</h4>Patients in the Surveillance, Epidemiology, and ...[more]

PMID: 24321784

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Use of bone scan during initial prostate cancer workup, downstream procedures, and associated Medicare costs.

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Use of bone scan during initial prostate cancer workup, downstream procedures, and associated Medicare costs.

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