Login to Access Video or Poster Abstract: MP21-11
Sources of Funding: This study was conducted with the support of the Institute for Translational Sciences at the University of Texas Medical Branch, supported in part by a Clinical and Translational Science Award Mentored Career Development (KL2) Award (KL2TR001441) from the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), Comparative Effectiveness Research on Cancer in Texas (CERCIT) (RP140020) and the National Cancer Institute (NCI) (K05 CA134923) (SBW). This study was funded in part by the NIH Bladder SPORE (5P50CA091846-03) (AMK). This work was supported in part by the Duncan Family Institute and a fellowship from The University of Texas MD Anderson Cancer Center's Halliburton Employees Foundation (Huo). We thank Dr. Gary Deyter from the Department of Health Services Research at The University of Texas MD Anderson Cancer Center for reviewing and editing the manuscript. This study used the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the SEER program tumor registries in the creation of the SEER database.

Introduction

This study examined utilization patterns and predictors for use of positron emission tomography–computed tomography (PET/CT), magnetic resonance imaging (MRI), and computed tomography (CT) among Medicare beneficiaries diagnosed with bladder cancer.

Methods

We used the Surveillance, Epidemiology and End Results (SEER)-Medicare linked databases to analyze claims data for 36,855 patients aged 60-90 years diagnosed with bladder cancer from 2004 to 2011. The Cochran-Armitage test for trend was used to determine whether significant changes in the proportion of patients receiving advanced imaging after cancer diagnosis occurred during the time interval; trends in the usage of the imaging modality types were assessed. Multivariable logistic regression modeling was conducted to analyze potential demographic and clinical predictors associated with receipt of advanced imaging. The costs of imaging were measured using Medicare payments.

Results

While the overall trend of imaging use remained essentially unchanged over the study period, there was a significant decrease in the proportion of patients who received conventional imaging modalities (MRI and CT; P < .05) and a significant increase in the proportion of patients receiving the more advanced imaging modality (PET/CT; P < .0001). On multivariable analysis, receipt of PET/CT was significantly higher in female patients, Non-Hispanics, residents in West Census region, patients with higher grade tumors, those diagnosed with advanced stage disease, hydronephrosis, and those that received radical cystectomy and chemotherapy. In the cost analysis, the estimated national excess medical spending for advanced imaging was $6.1 million.

Conclusions

The sharp increase of advanced imaging (PET/CT) and substantial costs associated with this rapid adoption as we have documented suggests that further efforts should be made to evaluate the clinical and economic benefits of PET/CT imaging and to elucidate its appropriateness of use among bladder cancer patients.

Funding

This study was conducted with the support of the Institute for Translational Sciences at the University of Texas Medical Branch, supported in part by a Clinical and Translational Science Award Mentored Career Development (KL2) Award (KL2TR001441) from the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), Comparative Effectiveness Research on Cancer in Texas (CERCIT) (RP140020) and the National Cancer Institute (NCI) (K05 CA134923) (SBW). This study was funded in part by the NIH Bladder SPORE (5P50CA091846-03) (AMK). This work was supported in part by the Duncan Family Institute and a fellowship from The University of Texas MD Anderson Cancer Center's Halliburton Employees Foundation (Huo). We thank Dr. Gary Deyter from the Department of Health Services Research at The University of Texas MD Anderson Cancer Center for reviewing and editing the manuscript. This study used the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the SEER program tumor registries in the creation of the SEER database.