Impact of USPSTF recommendations on utilization of PSA screening in Medicare beneficiaries.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 166-166
Author(s):  
Rahul Ramesh Khairnar ◽  
Mark Mishra ◽  
Ebere Onukwugha
Keyword(s):  
Task Force ◽  
Specific Antigen ◽  
Age Groups ◽  
The United States ◽  
Study Cohort ◽  
Administrative Claims ◽  
Medicare Beneficiaries ◽  
Psa Screening ◽  
Medicare Population ◽  
The Impact

166 Background: Previous studies assessing the impact of the United States Preventive Services Task Force (USPSTF) recommendations on utilization of prostate-specific antigen (PSA) screening have not investigated longer-term impacts of the 2008 recommendations nor have they investigated the impact of the 2012 recommendations in the Medicare population. The study aim was to evaluate change in utilization of PSA screening, post USPSTF recommendations of 2008 and 2012, and to assess trends and determinants of receipt of PSA screening in the Medicare population. Methods: This retrospective study of male Medicare beneficiaries utilized Medicare Current Beneficiary Survey (MCBS) data and linked administrative claims from 2006-2013. Beneficiaries aged ≥65 years, with continuous enrollment in Parts A and B for each year they were surveyed were included in the study cohort. Beneficiaries with self-reported or claims-based diagnosis of prostate cancer were excluded. Beneficiaries with Medicare eligibility due to end stage renal disease or disability were also excluded. The primary outcome was receipt of PSA screening. Other measures include age groups (65-74 and ≥75), time periods (pre- and post-2008 and 2012 recommendations), and sociodemographic variables. Results: The study cohort consisted of 11,028 beneficiaries, who were predominantly white (87.56%), married (69.25%), and unemployed (84.4%); 52.21% beneficiaries were aged ≥75. Declining utilization trends for PSA screening were observed only in men aged ≥75 after 2008 recommendations and in both age groups after 2012 recommendations. The odds of receiving PSA screening declined by 17% percent in men aged ≥75 after the 2008 recommendations and by 29% in men aged ≥65 after the 2012 recommendations. Conclusions: The USPSTF recommendations of 2008 and 2012 against PSA screening were associated with declines in utilization of PSA screening during the study period. USPSTF recommendations play a significant role in affecting utilization patterns of health services. Future studies should evaluate if the proposed 2017 update to these recommendations advocating shared decision-making for PSA screening in men aged 55-69 increase utilization in this age-group.

Implications of the United States Preventive Services Task Force (USPSTF) recommendations on prostate cancer (PCa) stage migration.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 5071-5071
Author(s):  
Iris Yeong- Fung Sheng ◽  
Yu-Wei Chen ◽  
Moshe Chaim Ornstein ◽  
Timothy D. Gilligan ◽  
Brian I. Rini ◽  
...  
Keyword(s):  
Task Force ◽  
Financial Burden ◽  
Specific Antigen ◽  
The United States ◽  
Stage Migration ◽  
Psa Screening ◽  
Group 3 ◽  
Group 2 ◽  
The Impact ◽  
Group 1

5071 Background: Prostate specific antigen (PSA) screening has been controversial, given unrefined screening guidelines leading to overdiagnosis and overtreatment of “indolent” PCa. In 2008, the USPSTF recommended against PSA screening for men aged ≥75 and in 2012 broadened this recommendation to include all men. The impact of these changes is unstudied. We hypothesize that these screening changes could delay the diagnosis of advanced PCa. Methods: The Surveillance, Epidemiology and End Results Program (SEER) was used to identify men (age 55-69) diagnosed with PCa between 2004-2015. PCa stage was categorized as nodal (N1M0) and metastatic (NxM1). Trend analysis was stratified based on year 2004-2008 (group 1), 2009-2012 (group 2), and 2012-2015 (group 3). Using group 2 as a reference, multivariable logistic regression was used to identify predictors for N1M0 and NxM1 in each group. Results: From 2004-2015, there were 603,323 eligible men diagnosed with PCa (group 1: 262,240 men, group 2: 210,045 men, group 3: 131,038 men). In group 1, 1.4% had N1M0 and 2.8% had NxM1. In group 2, 1.6% had N1M0 and 3.7% had NxM1. In group 3, 1.4% had N1M0, and 6.1% had NxM1. The adjusted odds ratio (AOR) of N1M0 was 0.78 (95%CI 0.74-0.82; p<0.0001) in group 1 and 1.71 (95%CI 1.63-1.80; p<0.0001) in group 3. Similar AOR trends were seen in NxM1 (group 1, 0.71; 95%CI 0.68-0.73, p< 0.0001 vs. group 3, 1.70; 95% CI 1.63-1.75, p<0.0001). (Table) Subset analysis of non-eligible patients (age >70 and <55) showed a similar stage migration. Conclusions: With each USPSTF recommendation, there have been significantly more diagnoses of advanced PCa; suggesting stage migration. The sequelae of having advanced PCa include more aggressive treatments, increased financial burden, and reduced quality of life. Future population studies are warranted to investigate whether the updated 2018 USPSTF recommendation now encapsulates the best target population.[Table: see text]

scholarly journals Prostate cancer screening among family physicians in Ontario: An update on attitudes and current practice

2017 ◽  
Vol 12 (2) ◽  
pp. E53-8 ◽  
Author(s):  
Jason Paul Akerman ◽  
Christopher B. Allard ◽  
Camilla Tajzler ◽  
Anil Kapoor
Keyword(s):  
Prostate Cancer ◽  
Cancer Screening ◽  
Task Force ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Family Physicians ◽  
Preventive Health Care ◽  
The United States ◽  
Screening Practices ◽  
Psa Screening

Introduction: This study serves as an update of prostate cancer screening practices among family physicians in Ontario, Canada. Since this population was first surveyed in 2010, the Canadian Task Force on Preventive Health Care (CTFPHC) and the United States Preventive Services Task Force (USPSTF) released recommendations against prostate cancer screening.Methods: An online survey was developed through input from urologists and family practitioners. It was distributed via email to all members of the Ontario Medical Association’s Section on General and Family practice (11 657 family physicians). A reminder email was sent at two weeks and the survey remained active for one month.Results: A total of 1880 family physicians completed surveys (response rate 16.1%). Overall, 80.4% offered prostate cancer screening compared to 91.7% when surveyed in 2010. Physicians new to practice (two years or less) were the most likely to not offer screening (24.6%). A combination of digital rectal exam (DRE) and prostate-specific antigen (PSA) remained the most common form of screening (58.3%). Following the release of the CTFPHC recommendations, 45.6% of respondents said they now screen fewer patients. Participants were less familiar with national urological society guidelines compared to task force recommendations. The majority (72.6%) of respondents feel PSA screening leads to overdiagnosis and treatment. Those surveyed remained split with respect to PSA utility.Conclusions: Data suggest a decline in screening practices since 2010, with newer graduates less likely to offer screening. CFTPHC and USPSTF recommendations had the greatest impact on clinical practice. Those surveyed were divided with respect to PSA utility. Some additional considerations to PSA screening in the primary care setting, including patient-driven factors, were not captured by our concise survey.

Impact of the USPSTF recommendations on prostate cancer stage migration and de-novo metastatic prostate cancer.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 166-166 ◽  
Author(s):  
Yu-Wei Chen ◽  
Ruby Gupta ◽  
Moshe Chaim Ornstein ◽  
Brian I. Rini ◽  
Timothy D. Gilligan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Metastatic Disease ◽  
De Novo ◽  
Task Force ◽  
Specific Antigen ◽  
P Value ◽  
Stage Migration ◽  
Nodal Disease ◽  
Psa Screening ◽  
The Impact

166 Background: The US Preventive Services Task Force (USPSTF) recommended against prostate specific antigen (PSA) screening for men aged≥75 in 2008 and all men in 2012 in an effort to reduce overdiagnosis and overtreatment of men with prostate cancer (PCa). This recommendation may delay diagnosis of clinically significant PCa. Methods: The Surveillance, Epidemiology and End Results Program (SEER) was used to identify men diagnosed with PCa between 2004-2015. PCa stage was categorized as localized (N0M0), nodal (N1M0) and metastatic (NxM1). Trend analysis was stratified on age group (PSA screening eligible was defined as age 55-69 according to the 2018 updated USPSTF recommendation). Multivariable logistic regression was used to identify predictors for nodal and metastatic disease. Results: Between 2004-2015, there were 603,323 men with PCa identified. Metastatic disease accounted for 2.8% of PCa in 2004-2008, 3.7% in 2009-2012, and 6.1% in 2013-2015. In men eligible for PCa screening, metastatic disease increased from 1.9% in 2004-2008, to 2.6% in 2009-2012, to 4.2% in 2013-2015; nodal disease increased from 1.4% to 1.6% to 2.6%, respectively (both p-value for trend< 0.0001). This stage migration was also observed in non-screening eligible groups (age >70 and <55). Compared with PCa diagnosed in 2009-2012, PCa diagnosed in 2013-2015 had higher odds of metastatic disease (AOR: 1.70, p-value<0.0001) or nodal disease (AOR: 1.71, p-value<0.0001). Conclusions: Men diagnosed with PCa in 2013-2015 were more likely to have metastatic or nodal disease, suggesting PCa stage migration since PSA screening was recommended to be discontinued in 2012. Although the impact of PSA screening on PCa mortality remains debatable, the reduced quality of life with advanced Pca should not be overlooked. Future population studies are warranted to investigate the influence of the updated 2018 USPSTF recommendation. [Table: see text]

Prostate cancer screening practice among men age 75 and older: Results from a national survey

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16034-e16034
Author(s):  
K. E. Hoffman ◽  
A. V. D'Amico
Keyword(s):  
Prostate Cancer ◽  
Health Status ◽  
Task Force ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Poor Health ◽  
Study Cohort ◽  
Poor Health Status ◽  
Screening Practice ◽  
Psa Screening

e16034 Background: The U.S. Preventative Services Task Force recently recommended not to screen men aged 75 and older for prostate cancer. This study evaluated the use of prostate specific antigen (PSA) screening among men age 75 and older prior to this declaration. Methods: The study cohort comprised 718 men age 75 or older without a history of prostate cancer who responded to the 2005 National Health Interview Survey, representing an estimated 4.47 million non-institutionalized men annually. Univariable and multivariable logistic regression was used to determine factors associated with PSA screening. Results: Of the 718 men, 19.2 % were age 85 or older, 42.2% reported fair or poor health, 24% had two or more significant diseases and 10.9% were dependent in at least one instrumental activity of daily living (IADL). More than half (51.6%) underwent PSA screening within the previous two years. Men who reported poor health status (42.2 vs. 55.2%, p=0.005) and men who had difficulty with at least one IADL (37.4 vs. 53.3%, p=0.010) were less likely to have a screening PSA. After adjustment for age, race, education status, and physician access, poor health status (adjusted odds (AOR): 0.70, 95% CI (CI): 0.45 to 1.10; p = 0.119), two or more significant diseases (AOR: 0.78, CI: 0.48 to 1.27; p = 0.333) and difficulty with at least one IADL (AOR: 0.71, CI: 0.42, 1.20; p = 0.202) were not associated with the use of PSA screening. Of the 104 men likely to live for five years or less because of poor health, 35.0% underwent PSA screening. Conclusions: Health status, a predictor of life expectancy, should be considered when determining which men receive PSA screening. This would reduce the use of PSA screening in men unlikely to benefit. No significant financial relationships to disclose.

Clinical implications of the 2012 US Preventive Services Task Force (USPSTF) PSA screening recommendation in prostate cancer diagnoses and 5-year survival at a Minnesota safety net health care system.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 5051-5051
Author(s):  
Kevin Gale ◽  
Daniel Fellows Pease ◽  
Joseph Guinness ◽  
Andres Wiernik
Keyword(s):  
Prostate Cancer ◽  
Healthcare System ◽  
Task Force ◽  
Prostate Cancer Screening ◽  
Early Stage ◽  
Specific Antigen ◽  
Safety Net ◽  
Psa Screening ◽  
Number Needed To Screen ◽  
The Impact

5051 Background: Prostate specific antigen (PSA) screening for prostate cancer has declined following the USPSTF 2012 recommendation. How screening rates and prostate cancer diagnoses have subsequently changed in a racially diverse patient population is not well defined. In this study, we aim to determine the impact of the USPSTF screening recommendation in the Hennepin Healthcare System (HHS) in the state of Minnesota. Methods: A single-institution retrospective analysis of data from our electronic health record, to identify the characteristics of PSA screening and new prostate cancer diagnoses for men ≥50 years between 2008 and 2015. Data before and after May 2012 were compared. P-values were calculated using binominal and generalized linear models. Results: Nearly 22,000 patients underwent PSA screening from 2008 to 2015. PSA screening rates decreased after May 2012 for the four largest demographics represented (p < 0.001). Hispanics and Blacks were more likely to be screened when compared to Whites and Asians (p < 0.05). 319 cases of prostate cancer were diagnosed from 2008 to 2015 with 87 cases (27.3%) diagnosed by PSA-screening. The number needed to screen to diagnose one patient with prostate cancer at HHS was 137.5, and 9.5% of patients (1146 patients) had a false positive PSA that led to further testing or a biopsy. $56,090 was spent in screening costs per diagnosis of early stage prostate cancer via screening. Patients diagnosed from screening were less likely to present with high Gleason scores (8-10) compared to non-screening diagnosis (8% vs 23.3%, p < 0.01). The 5-year survival percentage (prostate cancer mortality) was improved for those patients diagnosed by PSA screening vs the non-screened group (100% vs 89.3%, p < 0.05). Conclusions: PSA screening has declined at HHS since the USPSTF recommendation against prostate cancer screening. Implementation of PSA screening in our healthcare system is expensive and leads to a high number of false positives. Despite this, the 5-year survival from prostate cancer is significantly higher when patients are diagnosed by PSA screening.

scholarly journals Prostate-Specific Antigen Screening According to Health Professional Counseling and Age in the United States

2022 ◽  
Vol 2022 ◽  
pp. 1-9
Author(s):  
Ray M. Merrill ◽  
Seth A. Otto ◽  
Eliza B. Hammond
Keyword(s):  
Health Professional ◽  
Task Force ◽  
Specific Antigen ◽  
The United States ◽  
Screening Methods ◽  
Professional Counseling ◽  
Psa Test ◽  
Psa Screening ◽  
The Past ◽  
The Us

Background. In 2018, the US Preventive Services Task Force recommended that PSA screening for prostate cancer involve men aged 55–69, based on a personal decision following consultation with a health professional. PSA screening in men aged 70 or older should only occur if symptoms exist. This study identifies the association between having a PSA test in the past two years and whether or not there was consultation with a health professional about the benefits and/or harms of PSA screening. Methods. Analyses were based on data involving men aged 40 years or older, who responded to PSA related questions in the 2018 BRFSS survey. Results. Approximately 32.0% (14.6% for ages 40–54, 41.7% for ages 55–69, and 49.8% for ages 70 years and older) of respondents had a PSA test in the past two years. Approximately 81.7% of these men had talked with a health professional about the benefits and/or harms of PSA screening, with 42.4% having discussed the benefits and harms, 54.6% having discussed the benefits only, and 3.0% having discussed the harms only. The odds of a PSA test in the past two years in men having talked with a health professional about the benefits and harms of the test versus no talk are 10.1 (95% CI 9.3–10.8), in men who talked with a health professional about the benefits only versus no talk are 10.8 (95% CI 10.0–11.6), and in men who talked with a health professional about the harms only versus no talk are 3.9 (95% CI 2.9–5.1). Conclusion. PSA screening is most common in men aged 70 or older, which is counter to the US Preventive Task Force recommendation. Most men having a PSA test have talked with a health professional about the test, but the talks tended to focus on just the benefits of screening and not both potential benefits and harms.

scholarly journals The Association of Veterans’ PSA Screening Rates With Changes in USPSTF Recommendations

2020 ◽  
Author(s):  
Daniel J Becker ◽  
Temitope Rude ◽  
Dawn Walter ◽  
Chan Wang ◽  
Stacy Loeb ◽  
...  
Keyword(s):  
Task Force ◽  
Statistical Tests ◽  
Specific Antigen ◽  
The United States ◽  
Veterans Health ◽  
Health Administration ◽  
Psa Screening ◽  
Psa Testing ◽  
Before And After ◽  
Preventative Services

Abstract Background In 2012, the United States Preventative Services Task Force (USPSTF) formally recommended against all prostate-specific antigen (PSA) screening for prostate cancer. Our goal was to characterize PSA screening trends in the Veterans Health Administration (VA) before and after the USPSTF recommendation and to determine if PSA screening was more likely to be ordered based on a veteran’s race or age. Methods Using the VA Corporate Data Warehouse, we created 10 annual groups of PSA-eligible men covering 2009-2018. We identified all PSA tests performed in the VA to determine yearly rates of PSA screening. All statistical tests were 2-sided. Results The overall rate of PSA testing in the VA decreased from 63.3% in 2009 to 51.2% in 2018 (P &lt; .001). PSA screening rates varied markedly by age group during our study period, with men aged 70-80 years having the highest initial rate and greatest decline (70.6% in 2009 to 48.4% in 2018, P &lt; .001). Men aged 55-69 years had a smaller decline (65.2% in 2009 to 58.9% in 2018, P &lt; .001) whereas the youngest men, aged 40-54 years, had an increase in PSA screening (26.2% in 2009 to 37.8% in 2018, P &lt; .001). Conclusions In this analysis of PSA screening rates among veterans before and after the 2012 USPSTF recommendation against screening, we found that overall PSA screening decreased only modestly, continuing for more than one-half of the men in our study. Veterans of different races had similar screening rates, suggesting that VA care may minimize racial disparities. Veterans of varying ages experienced statistically significantly differences in PSA screening trends.

scholarly journals The Medicare Current Beneficiary Survey (MCBS): Providing Unique Access to Data on the Medicare Population

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 908-908
Author(s):  
Hildie Cohen ◽  
Sarah Hoyt ◽  
Sara Navin ◽  
Jennifer Titus ◽  
Mia Ibrahim
Keyword(s):  
Health Care ◽  
Health Care Expenditures ◽  
The United States ◽  
Special Topic ◽  
Care Utilization ◽  
Medicare Beneficiaries ◽  
Data Set ◽  
Medicare Current Beneficiary Survey ◽  
Medicare Population ◽  
The Impact

Abstract The Medicare Current Beneficiary Survey (MCBS) is a continuous, multipurpose survey of a nationally representative sample of the Medicare population, conducted by the Centers for Medicare & Medicaid Services (CMS). It collects data on demographics, health insurance, health status, health care expenditures, satisfaction with care, and access to care for Medicare beneficiaries. The MCBS provides a unique source of information regarding beneficiaries aged 65 and over and beneficiaries aged 64 and below with disabilities residing in the United States that cannot be obtained solely through CMS administrative sources. For researchers interested in issues of health care utilization and cost, CMS releases two Limited Data Set (LDS) files for each data year and a Public Use File (PUF) freely available for download and use. Also, special topic based PUFs have been released on the impact of COVID-19 on Medicare beneficiaries. This presentation will demonstrate the importance of the MCBS for research on the Medicare population, discuss how researchers can access the data, where researchers can find published MCBS estimates, what content areas have recently been added, such as food insecurity, limited English proficiency, and COVID-19 vaccination uptake and what new content is on the horizon. The presentation will also discuss the operational challenges posed by the COVID-19 pandemic, and the content enhancement opportunities created by the public health emergency. It will conclude with a review of the suite of materials and documentation available for data users to enhance their research and utilize more timely data.

scholarly journals 1719. Respiratory Syncytial Virus-Associated Hospitalization Rates among US Infants: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S843-S843
Author(s):  
John M McLaughlin ◽  
Farid L Khan ◽  
Heinz-Josef Schmitt ◽  
Yasmeen Agosti ◽  
Luis Jodar ◽  
...  
Keyword(s):  
Public Health ◽  
Respiratory Syncytial Virus ◽  
Active Surveillance ◽  
Meta Analysis ◽  
The United States ◽  
Administrative Claims ◽  
Prevention Strategies ◽  
Hospitalization Rates ◽  
Syncytial Virus ◽  
The Impact

Abstract Background Understanding the true magnitude of infant respiratory syncytial virus (RSV) burden is critical for determining the potential public-health benefit of RSV prevention strategies. Although global reviews of infant RSV burden exist, none have summarized data from the United States or evaluated how RSV burden estimates are influenced by variations in study design. Methods We performed a systematic literature review and meta-analysis of studies describing RSV-associated hospitalization rates among US infants. We also examined the impact of key study characteristics on these estimates. Results After review of 3058 articles through January 2020, we identified 25 studies with 31 unique estimates of RSV-associated hospitalization rates. Among US infants &lt; 1 year of age, annual rates ranged from 8.4 to 40.8 per 1000 with a pooled rate= 19.4 (95%CI= 17.9–20.9). Study type was associated with RSV hospitalization rates (P =.003), with active surveillance studies having pooled rates per 1000 (11.1; 95%CI: 9.8–12.3) that were half that of studies based on administrative claims (21.4; 95%CI: 19.5–23.3) or modeling approaches (23.2; 95%CI: 20.2–26.2). Conclusion Applying the pooled rates identified in our review to the 2020 US birth cohort suggests that 73,680 to 86,020 RSV-associated infant hospitalizations occur each year. To date, public-health officials have used conservative estimates from active surveillance as the basis for defining US infant RSV burden. The full range of RSV-associated hospitalization rates identified in our review better characterizes the true RSV burden in infants and can better inform future evaluations of RSV prevention strategies. Disclosures John M. McLaughlin, PhD, Pfizer (Employee, Shareholder) Farid L. Khan, MPH, Pfizer (Employee, Shareholder) Heinz-Josef Schmitt, MD, Pfizer (Employee, Shareholder) Yasmeen Agosti, MD, Pfizer (Employee, Shareholder) Luis Jodar, PhD, Pfizer (Employee, Shareholder) Eric Simões, MD, Pfizer (Consultant, Research Grant or Support) David L. Swerdlow, MD, Pfizer (Employee, Shareholder)

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