Changes in initial expenditures for benign prostatic hyperplasia evaluation in the Medicare population: a comparison to overall Medicare inflation

Abstract

Purpose: Benign prostatic hyperplasia creates significant expenses for the Medicare program. We determined expenditure trends for benign prostatic hyperplasia evaluative testing after urologist consultation and placed these trends in the context of overall Medicare expenditures.

Materials and methods: Using a 5% national sample of Medicare beneficiaries from 2000 to 2007 we developed a cohort of 40,253 with claims for new visits to urologists for diagnoses consistent with symptomatic benign prostatic hyperplasia. We assessed trends in initial inflation and geography adjusted expenditures within 12 months of diagnosis by evaluative test categories derived from the 2003 American Urological Association guideline on the management of benign prostatic hyperplasia. Using governmental reports on Medicare expenditure trends for benign prostatic hyperplasia we compared expenditures to overall and imaging specific Medicare expenditures. Comparisons were assessed by the Z-test and regression analysis for linear trends, as appropriate.

Results: Between 2000 and 2007 inflation adjusted total Medicare expenditures per patient for the initial evaluation of patients with benign prostatic hyperplasia seen by urologists increased from $255.44 to $343.98 (p <0.0001). Benign prostatic hyperplasia related imaging increases were significantly less than overall Medicare imaging expenditure increases (55% vs 104%, p <0.001). The increase in per patient expenditures for benign prostatic hyperplasia was significantly lower than the increase in overall Medicare expenditures per enrollee (35% vs 45%, p = 0.0015).

Conclusions: From 2000 to 2007 inflation adjusted expenditures increased for benign prostatic hyperplasia related evaluations. This growth was slower than the overall growth in Medicare expenditures. The increase in BPH related imaging expenditures was restrained compared to that of the Medicare program as a whole.

Figure 1. Total Expenditures on BPH Evaluative Care Tests and the Total Number of New Patients Seen by Urologists, 2000 to 2007

Expenditures on initial BPH care increased from $23,679,521 in 2000 to $32,279,399 in 2007 (p = 0.002). Urologists saw approximately 92,700 new BPH related patients in 2000 and 93,840 patients in 2007.

Figure 2. Changes in Expenditures by Category of Care Test, 2000 to 2007

Per patient expenditures for BPH evaluative tests increased from $255.44 in 2000 to $343.98 in 2007 (Figure 2; p < 0.0001). Although expenditures on recommended care per patient remained unchanged from 2000 to 2007 ($31.43 to $31.02; p = 0.1997; Figure 2), expenditures increased for optional care ($36.93 to $60.92; p < 0.0001), not recommended care ($167.92 to $222.61; p =0.0004) and serum creatinine ($19.15 to $29.43; p = 0.0014).

Figure 3. Changes in Expenditures within Optional Care, 2000 to 2007

Expenditures increased significantly for all categories of care: cytology ($9.66 to $14.15; p < 0.001), uroflow ($14.70 to $22.71; p < 0.001), and post void residual ($12.57 to $24.06; p < 0.001).

Figure 4. Changes in Expenditures within Not Recommended Care, 2000 to 2007

Expenditures increased for CMG ($14.76 to $19.90; p = 0.0063), pressure flow urodynamic studies ($3.28 to $7.98; p < 0.001), cystoscopy ($72.70 to $83.83; p = 0.023), and upper tract imaging ($41.90 to $78.21; p < 0.0001). Expenditures remained unchanged for renal and prostatic ultrasound ($32.04 to $34.60; p = 0.0883).

Figure 5. Changes in Imaging Related Expenditures, 2000 to 2007

Expenditures increased significantly for post void residual (p<0.0001) and upper tract imaging (p<0.0001). Upper tract imaging had the most significant rate of growth.