Risk of Hospitalization Following Primary Treatment for Prostate Cancer: Beyond the Abstract
Currently, the Centers for Medicare and Medicaid Services (CMS) has initiated a hospital readmission reduction program in accordance with the Affordable Care Act to reduce payments to hospitals with excessive readmissions. While prior studies have examined 30 and 90-day readmission rates, the use of relatively short readmission time intervals may inaccurately assess delayed hospitalization rates following prostate cancer treatment. Herein, we provide one of the first population-based analyses to further discern determinants costs of hospitalization following primary treatment for prostate cancer.
Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database from 2004 and 2009, we identified 29,571 patients diagnosed with localized prostate cancer age 66–75 years without significant comorbidity who underwent primary surgery or radiotherapy. We compared the rates of all cause and toxicity-related hospitalization that occurred within 1 year following initiation of definitive therapy. We found men who underwent surgery rather than radiotherapy had lower odds of being hospitalized for any cause following therapy. Moreover, men who underwent radiotherapy rather than surgery had lower odds of being hospitalized for treatment-related complications with external beam radiotherapy/IMRT having 16% lower odds of hospitalization from treatment-related complications than patients undergoing surgery. However, using propensity score weighted analyses there was no significant difference in the odds of hospitalization from treatment-related complications for men who underwent surgery versus radiotherapy. Patients hospitalized for treatment-related complications following radiotherapy were costlier than patients who underwent surgery.
These results have important implications regarding prostate cancer treatments and health policy decision-making. First, in multivariable analyses we found that men treated with surgery were more likely to be hospitalized due to a treatment-related complication than men treated with radiation therapy. However, propensity score weighted analyses identified no significant difference in treatment-related hospitalization except patients who underwent external beam radiotherapy/IMRT had a 16% lower odds of treatment-related hospitalization than patients undergoing surgery. While other studies have critically assessed complications and additional procedures following either surgery or radiotherapy, selection bias may have confounded those results and patients treated with radiotherapy were older and more comorbid. These findings suggest comparable risk of treatment related hospitalization with patients who underwent external beam radiotherapy/IMRT having decreased risk when compared to surgery. Second, radiotherapy patients had higher attributable costs overall and related to complications when hospitalized when compared with surgery. Given payment penalties for increased readmissions in the setting of bundled payments with increased pressures to improve the value of care, further research exploring hospitalization risks beyond 30 or even 90-days from prostate cancer treatment are needed to improve allocation of resources in the current health care environment. Lastly, while we describe risk of hospitalization following primary treatment for prostate cancer within 1 year we cannot comment the long-term risk which is important when considering radiotherapy side-effects which may take many years to develop.
In summary, with the exception of men who underwent external beam radiotherapy/IMRT, there was no statistically significant difference in the odds of hospitalization from treatment-related complications. Costs from hospitalization after treatment were significantly higher for men undergoing radiation therapy than surgery. Our findings may guide health policy decision-making in regards to discerning quality and costs of prostate cancer care in the context of penalties linked to hospital readmissions and bundled payment models.
Written by: Stephen B. Williams, M.D.
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