Introduction:
Advances in healthcare have led to improved outcomes across the medical field. However, these advances often come at high costs creating additional financial hardships for patients – a phenomenon referred to as financial toxicity. Evaluation of healthcare spending among surgical subspecialties is often focused on procedural costs, however, there is a significant proportion of spending that can also be attributed to prescribed medications. This study aims to evaluate overall drug expenditure of different surgical specialties through Medicare Part D (MPD). Specifically, we sought to identify urology’s overall share of total MPD costs, including claims and beneficiaries, and their overall contribution to healthcare costs that may lead to patient financial toxicity. We also investigate causes of increased spending, as well as the factors that contribute to a provider being categorized as a high-cost prescriber under MPD.
Methods:
Using Medicare Fee-For Service Provider Utilization and Payment Data: Part D Prescriber Summary, we extracted total Medicare Part D beneficiaries, claims, and drug spending for each surgical specialty. We identify and report the frequency of high-cost prescribers, defined as annual drug costs in the top quartile, in each surgical specialty. We also assess regional variations within these parameters. Descriptive statistics are reported, as well as results of uni- and multi-variable regression models generated to identify factors contributing to the likelihood of being categorized as a high-cost prescriber.
Results:
A total of 106,011 prescribers were identified and aggregate drug cost for all surgical specialties in 2018 was noted to be $5.62 billion dollars. Of the 106,011 prescribers, 9,944 were urologists. Among those 9,944 urologists, 72% (7121/9944) of urologists in our study were identified as high-cost prescribers, which was the highest percentage among all specialties. The next highest was ophthalmology with 69% (12780/18462) followed by gynecology with 14% (3251/23774). Multivariable analysis identified urologists as more likely to be high-cost prescribers (OR: 49.0 [45.03-53.21], p < 0.01). Compared to the Midwest, surgeons located in the Northeast, Southeast, Pacific-West, and Southwest regions were more likely to be high-cost prescribers (OR: 1.48 [1.42-1.54], 1.35 [1.29-1.41], 1.28 [1.22-1.34], and 1.13 [1.08-1.19] respectively).
Conclusion:
Urologists contribute more significantly to medication costs under the Medicare Part D program when compared to other surgical specialties. This is likely caused by high-cost medications for urologic cancer care and contributes to the high proportion of MPD spending. Given the significant effects of financial toxicity on health-related quality of life, further investigation is needed to determine methods to reduce spending while optimizing patient outcomes.
Funding: N/A
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Medical Spending in Urology: An Analysis of Medicare Part D and Urology’s Contribution to Financial Toxicity
Category
Health Services
Description
Poster #32
Wednesday, Dec 1
3:00 p.m. - 4:00 p.m.
Health Services/Penile Cancer
Presented By: Spencer Liem
Authors:
Spencer Liem
Timothy Demus
George Wayne
Jorge Pereira