Are changes in US practices for androgen deprivation therapy financially motivated?

Abstract

This commentary discusses the retrospective study by Weight and colleagues, which evaluated the practice patterns of US physicians using androgen deprivation therapy (either medical castration with luteinizing hormone-releasing hormone [LHRH] agonists or surgical castration by orchiectomy) for the treatment of Medicare patients with prostate cancer during 2001–2005. In 2003, the enactment of the Medicare Modernization Act (MMA), which lowered reimbursement for LHRH analog administration, was introduced. The authors found that LHRH agonist use increased in 2001–2003, and decreased in 2004 and 2005, while surgical castration rates increased. The authors speculated that the treatment decisions for androgen deprivation therapy were financially influenced. Although this study highlights the possible influence that reimbursement levels might have in the decision to prescribe androgen deprivation therapy, the study has several limitations, and the conclusion that financial incentives were solely responsible for the observed decrease in LHRH agonist use can not be made.