Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; VA Health Services Research & Development, Center for Clinical Management and Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.
Department of Urology, University of Michigan Medical School, Ann Arbor, MI.
Urology. 2019 Sep;131:176-183. doi: 10.1016/j.urology.2019.05.012. Epub 2019 May 25.
To investigate the adoption of abiraterone and enzalutamide by urologists. Abiraterone and enzalutamide are oral therapies approved for the treatment of metastatic castration-resistant prostate cancer, a disease most commonly treated by medical oncologists.
Using the Medicare Part D Public Use Files from 2013 to 2016, we identified total abiraterone and enzalutamide prescriptions 2013-2016 and urologists who prescribed moderate to high volumes of these drugs. We then characterized the urologist practices of those urologists according to practice context (eg, single-specialty group) using data from the Centers for Medicare and Medicaid Services, and the geographic distribution of those providers.
We found abiraterone prescriptions increased from 71,423 in 2013 to a peak of 100,371 in 2015 and enzalutamide prescriptions continued to increase from 29,572 in 2013 to 100,980 in 2016. Prescriptions by urologists increased between 2013 and 2016 while prescriptions by other specialties plateaued. The number of moderate-high prescribing urologists increased from 98 (abiraterone) and 22 (enzalutamide) in 2013, to 301 (abiraterone) and 671 (enzalutamide) by 2016 with 1063 unique urologists prescribing moderate-high volumes of either drug between 2013 and 2016. Among urologists who prescribe androgen deprivation therapy, 5% were moderate-high prescribers of abiraterone and 12% of enzalutamide in 2016. The majority of moderate-high prescribing urologists were in single-specialty groups (70%).
Urologists are increasingly prescribing oral therapies for metastatic castration-resistant prostate cancer. Understanding the distribution of urologists specializing in castration-resistant prostate cancer therapeutics will help guide future interventions to optimize the care for this important patient population.
研究泌尿科医生对阿比特龙和恩杂鲁胺的应用情况。阿比特龙和恩杂鲁胺是两种已获批用于治疗转移性去势抵抗性前列腺癌的口服药物，该疾病通常由肿瘤内科医生进行治疗。
利用 2013 年至 2016 年的医疗保险处方数据库（Medicare Part D Public Use Files），我们确定了 2013 年至 2016 年期间的阿比特龙和恩杂鲁胺总处方量以及开具这些药物中高剂量处方的泌尿科医生。然后，我们利用医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）的数据以及这些提供者的地理分布情况，根据实践环境（例如，单一专科小组）对这些泌尿科医生的实践情况进行了特征描述。
我们发现，2013 年阿比特龙的处方量为 71423 张，到 2015 年达到峰值 100371 张，而恩杂鲁胺的处方量则从 2013 年的 29572 张持续增加到 2016 年的 100980 张。2013 年至 2016 年间，泌尿科医生的处方量有所增加，而其他专业医生的处方量则趋于稳定。2013 年开具中高剂量处方的泌尿科医生有 98 名（阿比特龙）和 22 名（恩杂鲁胺），到 2016 年分别增加到 301 名（阿比特龙）和 671 名（恩杂鲁胺），2013 年至 2016 年间共有 1063 名泌尿科医生开具了中高剂量的这两种药物。在开具雄激素剥夺疗法的泌尿科医生中，2016 年有 5%的医生开具中高剂量的阿比特龙，12%的医生开具中高剂量的恩杂鲁胺。大多数中高剂量处方的泌尿科医生都在单一专科小组（70%）中。
泌尿科医生越来越多地为转移性去势抵抗性前列腺癌患者开具口服治疗药物。了解专门治疗去势抵抗性前列腺癌的泌尿科医生的分布情况，将有助于指导未来的干预措施，优化对这一重要患者群体的治疗。
