Department of Radiology, New York University Langone Medical Center, New York, New York.
Harvey L. Neiman Health Policy Institute, Reston, Virginia.
J Urol. 2018 Jul;200(1):89-94. doi: 10.1016/j.juro.2018.01.071. Epub 2018 Feb 2.
We assessed the changing use of prebiopsy prostate magnetic resonance imaging in Medicare beneficiaries.
Men who underwent prostate biopsy were identified in 5% Medicare RIFs (Research Identifiable Files) from October 2010 through September 2015. We evaluated the rate of prebiopsy prostate magnetic resonance imaging, defined as any pelvic MRI 6 months or less before biopsy with a prostate indication diagnosis code. Temporal changes were determined as well as variation by geography and among populations.
In male Medicare beneficiaries the prebiopsy magnetic resonance imaging use rate increased from 0.1% in 2010 to 0.7% in 2011, to 1.2% in 2012, to 2.9% in 2013, to 4.7% in 2014 and to 10.3% in 2015. In 2015 the prebiopsy prostate magnetic resonance imaging rate varied significantly by patient age, including 5.7% for greater than 80 years vs 8.4% to 9.3% for other age ranges (p = 0.040) as well as by race, including 5.8% in African American vs 10.1% in Caucasian men (p = 0.009) and geographic region, including 6.3% in the Midwest to 12.5% in the Northeast (p <0.001). The rate was highest in Wyoming at 25.0%, New York at 23.7% and Minnesota at 20.5% but it was less than 1% in 10 states.
Historical Medicare claims provide novel insights into the dramatically increasing adoption of magnetic resonance imaging prior to prostate biopsy. Following earlier minimal use the performance increased sharply beginning in 2013, exceeding 10% in 2015. However, substantial racial and geographic variation exists in adoption. Continued educational, research and policy efforts are warranted to optimize the role of prebiopsy magnetic resonance imaging and minimize sociodemographic and geographic disparities.
我们评估了 Medicare 受益人群中前列腺磁共振成像（MRI）在前列腺活检前的使用变化。
我们从 2010 年 10 月至 2015 年 9 月的 Medicare 审查识别档案（Research Identifiable Files，RIFs）中选取接受前列腺活检的男性患者。我们评估了前列腺 MRI 的使用率，定义为活检前 6 个月内任何有前列腺指征诊断代码的盆腔 MRI。我们还确定了时间变化以及地理和人群之间的差异。
在 Medicare 男性受益人群中，前列腺 MRI 的使用率从 2010 年的 0.1%增加到 2011 年的 0.7%，2012 年的 1.2%，2013 年的 2.9%，2014 年的 4.7%，2015 年的 10.3%。2015 年，前列腺 MRI 的使用率因患者年龄、种族和地理位置的不同而显著不同，年龄大于 80 岁的患者使用率为 5.7%，而其他年龄段的患者使用率为 8.4%至 9.3%（p=0.040），不同种族的患者使用率分别为非洲裔美国人 5.8%，白种人 10.1%（p=0.009），不同地理位置的患者使用率分别为中西部地区 6.3%，东北部地区 12.5%（p<0.001）。怀俄明州的使用率最高，为 25.0%，纽约州为 23.7%，明尼苏达州为 20.5%，但有 10 个州的使用率低于 1%。
Medicare 历史索赔为我们提供了有关前列腺活检前磁共振成像应用的急剧增加的新见解。自 2013 年开始，使用量开始急剧增加，到 2015 年超过 10%，在此之前，其使用率一直很低。然而，在采用方面仍存在明显的种族和地理差异。需要继续进行教育、研究和政策努力，以优化前列腺活检前磁共振成像的作用，并最大限度地减少社会人口和地理差异。
