Maganty Avinash, Kaufman Samuel R, Oerline Mary K, Faraj Kassem, Caram Megan E V, Ryan Andrew M, Shahinian Vahakn B, Hollenbeck Brent K
Department of Urology, Massachusetts General Hospital, Boston, MA.
Department of Urology, Massachusetts General Hospital, Boston, MA.
Urology. 2025 Feb;196:137-144. doi: 10.1016/j.urology.2024.11.009. Epub 2024 Nov 22.
To examine the relationship between market dynamics, in the form of commercial prices paid to urologists, and utilization of services, as measured by Medicare spending, in men with newly diagnosed prostate cancer.
We performed a retrospective national cohort study of Medicare beneficiaries with newly diagnosed prostate cancer between 2014 and 2019, with follow-up through 2020. The primary exposure was the commercial price index (ie, the ratio of commercial prices to Medicare prices for a common set of services performed by urologists). The primary outcome was Medicare spending for prostate cancer in the 12-month period after diagnosis.
Across zip codes, commercial prices were, on average, 190% of Medicare prices (range 102%-421%), with mean spending per beneficiary of $16,704. There was an inverse relationship between the price index and Medicare spending for men for prostate cancer. Specifically, standardized Medicare spending was $1485 (95%CI $939 to $2030) higher per beneficiary among those managed in zip codes at the bottom decile for commercial prices compared to the top decile. This effect was similar in the subgroup of men who underwent treatment, where standardized Medicare spending was $1461 (95%CI $848 to $2073) higher per beneficiary among those managed in zip codes in the bottom decile for commercial prices compared to the top decile.
Commercial prices for a set of frequently performed services are substantial higher than those paid by Medicare and vary widely across zip codes. Higher commercial prices were associated with significantly lower utilization, as measured by standardized Medicare spending, in men with newly diagnosed prostate cancer.
研究以支付给泌尿科医生的商业价格形式体现的市场动态与新诊断前列腺癌男性的服务利用情况（以医疗保险支出衡量）之间的关系。
我们对2014年至2019年间新诊断前列腺癌的医疗保险受益人进行了一项全国性回顾性队列研究，并随访至2020年。主要暴露因素是商业价格指数（即泌尿科医生执行的一组常见服务的商业价格与医疗保险价格之比）。主要结局是诊断后12个月内前列腺癌的医疗保险支出。
在各个邮政编码区域，商业价格平均是医疗保险价格的190%（范围为102% - 421%），每位受益人的平均支出为16,704美元。前列腺癌男性的价格指数与医疗保险支出之间存在负相关关系。具体而言，与商业价格处于最高十分位的邮政编码区域相比，商业价格处于最低十分位的邮政编码区域管理的男性中，每位受益人标准化医疗保险支出高出1485美元（95%置信区间为939美元至2030美元）。在接受治疗的男性亚组中，这种效应类似，与商业价格处于最高十分位的邮政编码区域相比，商业价格处于最低十分位的邮政编码区域管理的男性中，每位受益人标准化医疗保险支出高出1461美元（95%置信区间为848美元至2073美元）。
一组经常执行的服务的商业价格显著高于医疗保险支付的价格，并且在各个邮政编码区域差异很大。以标准化医疗保险支出衡量，新诊断前列腺癌男性中，较高的商业价格与显著较低的服务利用率相关。
