06 Jun Radical Prostatectomies: Referral to High Volume Centers Saves Money
MedicalResearch.com Interview with:
Sarmad Sadeghi MD, MS, PhD
Assistant Professor of Medicine
Norris Comprehensive Cancer Center
University of Southern California
MedicalResearch.com: What is the background for this study?
Dr. Sadeghi: Several years ago analyses of outcomes for radical prostatectomy highlighted the significant impact of surgical experience on the oncological outcome for the patients. In this case experience was measured by the number of radical prostatectomies performed by the surgeon, and oncological outcome was measured by treatment failure rates (rising PSA). Despite this data, the move for redirecting patients to “high volume centers” where more experienced surgeons perform the operation has been sluggish. There was insufficient data on what is involved in referring patients to high volume centers and whether or not such action is cost effective.
In a previous study we demonstrated that for every referral to a high volume center, there would be an average of $1,800 over a follow-up period of 20 years in societal cost savings. The main source of these savings is fewer treatment failures.
The next question was who is a good candidate for referral and whether these savings can offset the referral costs.
MedicalResearch.com: What are the main findings?
Dr. Sadeghi: In this study we addressed this question. Using Medicare provider claims data in 2012 and 2013 we identified providers with below average surgical volume in a given year and searched for the closest top 10 percentile provider in the same year. We propose that a travel distance of 100 miles is reasonable and is associated with minimal referral costs. Our results show that about 30% of patients that undergo treatment with surgeons with below average surgical volume, and more than 50% of these patients are within driving distance of a surgeon in the top 10 percentile of surgical volume.
MedicalResearch.com: What should readers take away from your report?
Dr. Sadeghi: Finding a highly experienced surgeon is important for prostate cancer surgery, and most of the time such a surgeon can be found within driving distance.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Sadeghi: A lot is changing in this field and surgical outcomes are improving as a result of new technology and concentration of experience. While some of the newer technology promises improved standardization of surgical techniques and, by proxy, outcomes, these assumptions have not been empirically investigated.
MedicalResearch.com: Is there anything else you would like to add?
Dr. Sadeghi: The role of experience in outcomes does not appear to be limited to radical prostatectomy. Whether it is bariatric surgery of radical cystectomy for bladder cancer, experience seems to make a difference in the outcomes. With cancer surgery, consequences of treatment failure could have significant implications for patients and the society. Payers may explore such referral patterns as a way not only to improve outcomes and therefore quality of care, but also to reduce costs. As the costs of cancer care continue to rise and patients continue to live longer, the impact of treatment failure as a result of below average surgical experience will further tip the balance in favor of higher surgical experience.
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Citation: Abstract presented at 2016 ASCO meeting
The Opportunity Cost of Radical Prostatectomies Performed by Low-Volume Providers
J Clin Oncol 34, 2016 (suppl; abstr 1553)
Author(s): Afsaneh Barzi, David I. Quinn, Gregory Idos, Heinz-Josef Lenz, Sarmad Sadeghi; University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; University of Southern California, Los Angeles, CA
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