Introduction

Clinical trials have suggested that pelvic floor rehab (PFR) can improve early urinary control following radical prostatectomy. However, the details surrounding its use in clinical practice and its contribution to cost and value are not well understood. In this context, we examined the use of PFR in a diverse statewide quality improvement collaborative, including patient characteristics, implementation patterns, and costs.

Methods

Using registry data from the Michigan Urological Surgery Improvement Collaborative and claims data from Michigan Value Collaborative, we identified all men who underwent a laparoscopic radical prostatectomy from 04/2014 through 11/2015 with insurance from Medicare or a large commercial payer. All men reported pre-operative urinary function using the STAR questionnaire with scores ranging from 0 (worst) to 21 (best). We compared patient demographics, cancer characteristics, pre-operative urinary function, and 90-day total episode costs of patients who did and did not receive PFR.

Results

142 men met our inclusion criteria, of whom 53 (37%) received pelvic floor rehab. There were no differences in patient or cancer characteristics among patients who did and did not receive PFR. Patients initiated PFR an average of 34 days after discharge (range 15-83 days). Mean baseline urinary function scores were worse for PFR patients (17.8 vs 19.3, p=0.01). Ninety-day episode costs were similar in the two cohorts, with PFR contributing an average of $422, or 3% of total episode costs.

Conclusions

In a statewide collaborative, PFR is used in the minority of cases, but its use appears to be concentrated among patients with worse baseline urinary function. Incremental costs from PFR are modest, accounting for 3% of 90-day episode costs. In the era of value-based care, decisions about further expanding this therapy will depend on studying its comparative impact on post-operative patient reported outcomes in large groups of non-clinical trial patients.

Funding

Blue Cross and Blue Shield of Michigan