National Trends in Active Surveillance for Prostate Cancer: Validation of Medicare Claims-based Algorithms

• Published in: Urology (Ridgewood, N.J.) N.J.), 2018-10, Vol.120, p.96-102
• Main Authors: Modi, Parth K., Kaufman, Samuel R., Qi, Ji, Lane, Brian R., Cher, Michael L., Miller, David C., Hollenbeck, Brent K., Shahinian, Vahakn B., Dupree, James M.
• Format: Article
• Language: English
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2018.06.037

To better describe the real-world use of active surveillance. Active surveillance is a preferred management option for low-risk prostate cancer, yet its use outside of high-volume institutions is poorly understood. We created multiple claims-based algorithms, validated them using a robust clinical registry, and applied them to Medicare claims to describe national utilization. We identified men with prostate cancer from 2012-2014 in a 100% sample of Michigan Medicare data and linked them with the Michigan Urologic Surgery Improvement Collaborative (MUSIC) registry. Using MUSIC treatment assignment as the standard, we determined the performance of 8 claims-based algorithms to identify men on active surveillance. We selected 3 algorithms (the most sensitive, the most specific, and a balanced algorithm incorporating age and comorbidity) and applied them to a 20% national Medicare sample to describe national trends. We identified 1186 men with incident prostate cancer and completely linked data. Eight algorithms were tested with sensitivity ranging from 23.5% to 88.2% and specificity ranging from 93.5% to 99.1%. We found that the use of surveillance for men with incident prostate cancer increased from 2007 to 2014, nationally. However, among all men in the population, there was a large decrease in the rate of prostate cancer diagnosis and an increased or stable rate in the use of active surveillance, depending on the algorithm used. Less than 25% of men on active surveillance underwent a confirmatory prostate biopsy. We describe the performance of claims-based algorithms to identify active surveillance.