National trends in surgical therapy for benign prostatic hyperplasia in the United States (2000-2008).

OBJECTIVE: To report an update of the change in usage trends for different surgical treatments of benign prostatic hyperplasia (BPH) among the United States Medicare population data from 2000-2008. The rate of usage of thermotherapy and laser therapy in the surgical treatment of BPH has been changing over the past decade in conjunction with a steady decrease of transurethral resection of the prostate (TURP). METHODS: Using the 100% Medicare carrier file for the years 2000-2008, we calculated counts and population-adjusted rates of BPH surgery. Rates of TURP, thermotherapy, and laser-using modalities were calculated and compared in relation to age, race, clinical setting, and reimbursement. RESULTS: After years of a steady rise, the total rate of all BPH procedures peaked in 2005 at 1078/100,000 and then declined by 15.4% to 912/100,000 in 2008. TURP rates continued to decline from 670 in 2000 to 351/100,000 in 2008. Rates of microwave thermoablation peaked in 2006 at 266/100,000 and then declined 26% in 2008. Laser vaporization almost completely replaced laser coagulation and in 2008 was the most commonly performed procedure second to TURP, with the majority performed as outpatient procedures (70%) and an increasing percentage in the office (12%). Men between ages 70 and 75 had the highest rate of procedures. Reimbursement rates correlate using some but not all procedures. Racial disparities reported previously appear to have resolved. CONCLUSION: Surgical treatment of BPH continues to change rapidly. TURP continues to decline and laser vaporization is the fastest growing modality. There is a big shift toward outpatient/office procedures. Reimbursement rates do not appear to have a consistent effect on usage.

Practice patterns in benign prostatic hyperplasia surgical therapy: the dramatic increase in minimally invasive technologies.

PURPOSE: We describe the trends in transurethral prostatectomy and minimally invasive surgical treatments for benign prostate hyperplasia from 1999 through 2005 among elderly male Medicare beneficiaries. MATERIALS AND METHODS: Benign prostatic hyperplasia surgeries were identified using the annual 100% Medicare carrier files which contain physician claims for services reimbursed under Medicare Part B. The annual age group specific procedure rates as well as the age adjusted rates by race and percent of each procedure performed in different clinical settings were calculated. RESULTS: The total number of benign prostatic hyperplasia procedures increased 44% from 88,868 in 1999 to 127,786 in 2005. The minimally invasive surgical treatment procedure counts increased 529% from 11,582 to 72,887 and the rates increased 439% from 136 to 678 per 100,000 males during that period. The transurethral prostate resection rate decreased approximately 5% per year. By 2005 minimally invasive surgical treatment procedures accounted for 57% of total benign prostatic hyperplasia surgeries, while transurethral prostate resection accounted for only 39%. Almost all transurethral microwave thermotherapy, 86% of transurethral needle ablation and 54% of laser coagulation procedures were performed in office clinics, and 78% of laser vaporization procedures were performed in hospital outpatient clinics. Black beneficiaries were 17% less likely to receive minimally invasive surgical treatment than whites in 2005. CONCLUSIONS: The increase of total benign prostatic hyperplasia procedure rate was driven by a marked increase in minimally invasive surgical treatment and a continuing decrease of transurethral prostate resection. Differences in the use of minimally invasive surgical treatment across age and racial groups persisted. This dramatic change in the pattern of benign prostatic hyperplasia surgical treatment may have a profound impact on health care expenditures and outcomes, and requires further investigation.

Unequal use of new technologies by race: the use of new prostate surgeries (transurethral needle ablation, transurethral microwave therapy and laser) among elderly Medicare beneficiaries.

PURPOSE: We compared the availability and use of transurethral microwave therapy, transurethral needle ablation, contact or noncontact laser therapy and transurethral resection of the prostate among elderly black and white Medicare beneficiaries. MATERIALS AND METHODS: We examined 100% Medicare Inpatient, Outpatient, Carrier and Denominator files of men 65 years old or older who underwent these procedures in 1999 through 2001. White-to-black race rate ratios for each procedure were computed for the entire United States, as well as for a restricted set of counties in which procedures were available to black beneficiaries. RESULTS: A total of 170,067 TURP, 16,953 TUMT, 5,353 TUNA and 12,134 Laser procedures were performed during 3 years. Nationally there was only a 3% difference in the age adjusted TURP rates between white and black men (6.13 and 5.94 per 1,000 person-years, respectively). However, the age adjusted rates for TUMT and TUNA among white men were about twice those among black men (0.63 vs 0.31 and 0.20 vs 0.10 per 1,000 person-years, respectively). Laser rates were 17% higher among white men than among black men (0.44 vs 0.38 per 1,000 person-years). Large geographic variation existed in the new procedure rates. Negative binomial regression analysis confirmed the national findings in those counties in which the procedures were available to black men. Adjusted white-to-black rate ratios were 1.96 (95% CI 1.70-2.25) for TUMT, 2.33 (95% CI 1.87-2.90) for TUNA and 1.36 (95% CI 1.16-1.59) for Laser. CONCLUSIONS: After controlling for availability, elderly black Medicare beneficiaries were less likely to undergo the new BPH procedures than white beneficiaries, while the usage difference for TURP remained small.