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Unequal Utilization of New Technologies by Race The Use of New Prostate Surgeries (TUNA and TUMT) among Medicare Elderly Beneficiaries. Xinhua Yu, PhD, MBBS A. Marshall McBean, MD, MSc Debra S. Caldwell, MS Research Data Assistance Center University of Minnesota Janet A. Anderson

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Unequal Utilization of New Technologies by Race The Use of New Prostate Surgeries (TUNA and TUMT) among Medicare Elderly Beneficiaries

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Unequal Utilization of New Technologies by RaceThe Use of New Prostate Surgeries (TUNA and TUMT) among Medicare Elderly Beneficiaries

Xinhua Yu, PhD, MBBS

A. Marshall McBean, MD, MSc

Debra S. Caldwell, MS

Research Data Assistance Center

University of Minnesota

Janet A. Anderson

Centers for Medicare and Medicaid Services

AcademyHealth Annual Research Meeting

June 7, 2004


Benign Prostate Hypertrophy (BPH)

  • Enlargement of prostate gland

  • Enlargement causes obstruction of outflow of urine and results in symptoms that significantly affect the quality of life

  • BPH affects three out of four men aged 70 or above

  • The prevalence of BPH for Blacks and Whites is not significantly different (Platz EA, Urology 59, 2002)


Treatment

  • Surgical:

    • transurethral resection of prostate (TURP)

    • transurethral microwave thermotherapy (TUMT)

    • transurethral needle ablation of prostate (TUNA)

    • Others (laser, electropulvarization, etc.)

  • Medical:

    • Watchful waiting

    • Drugs: alpha-blockers, finasteride


Rationale for Study

  • Black elderly Medicare beneficiaries have lower rates of many surgical procedures than Whites

  • TURP is performed 10% more frequently among elderly Whites than among Blacks (Wasson JH , J Urol. 2000 164(4))

  • New BPH surgeries do not require hospitalization and are not known to have any different side effects or complications than TURP

  • Little is known about the access (use) of new procedures in general, by race, and these new BPH procedures, in particular


Objective and Hypothesis

  • Examine racial difference of new BPH surgical procedures (TUMT and TUNA) among elderly Medicare beneficiaries

    • H0 - Blacks and Whites will receive new BPH surgical procedures at equal rates


Data Source/Case Identification

  • 100% Medicare claims and Denominator files from CMS

  • Identified any BPH procedures in Carrier, Inpatient, or Outpatient claim file from 1999-2001

  • BPH procedure:

    • CPT code: TURP (52601, 52612, 52614); TUMT (53850); TUNA (53852)

    • ICD 9-CM procedure code: TURP (60.29); TUMT (60.96); TUNA (60.97)

  • For procedures done in hospital or hospital out-patient, we matched physician and institution claims to avoid duplication


Inclusion Criteria

  • Black and white men only

  • Age ≥ 65

  • Enrolled in both Medicare Part A and Part B during the study years

  • Not in managed care during the study years

  • No End Stage Renal Disease

  • No history of prostate cancer


Study Cohort

Total sample size: 140,207 patients


Statistical Analysis

  • Separate analysis for

    • Total U.S.

    • those counties where new procedures were performed and had 10 or more black elderly male beneficiaries

  • Race-specific procedure rates per 10,000 person years

  • Direct standardization for age adjustment

  • Geographic heterogeneity was adjusted using Generalized Estimate Equation model (GEE), Poisson regression were used for adjusted rate ratios


Table 1: Age Adjusted BPH Procedure Rates among all U.S. Medicare Beneficiaries, 1999-2001

Rate: per 10,000 person years


Table 2: Age Adjusted Procedure Rates among Medicare Beneficiaries in Procedure Counties, 1999-2001

Rate: per 10,000 person years


Note: Colored areas were restricted counties

* Purple color: Procedure performed only in Whites


Table 3: White/Black Rate Ratio Adjusted for Geographic Variation among Medicare beneficiaries, 1999-2001

Data were restricted counties

CI: confidence interval


Conclusion

  • White:Black rate ratio for TURP are consistent with past reports and are an appropriate surrogate for the need for new surgery (RR=1.1)

  • Nationally, elderly Black Medicare beneficiaries were significantly less likely to receive new BPH surgical procedures than Whites (RR=2.1)

  • After adjusting for geographic variation, differences between the races persist (RR=1.7)


Discussion

  • Racial difference not due to availability of procedure

  • Severity of BPH

  • Patient preference

  • Cost to patient – future study


Acknowledgement

  • Research Data Assistance Center(ResDAC), University of Minnesota

  • Coverage and Analysis Group, Centers for Medicare and Medicaid Services (CMS)

  • Supported by CMS contract CMS 500-01-0043


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