Medicare-mandated shared decision making for left atrial appendage closure in clinical practice.

Introduction: The Centers for Medicare & Medicaid Services (CMS) required a shared decision-making (SDM) interaction, with an "independent" physician, before left atrial appendage closure (LAAC). The purpose of this study is to better understand how this requirement is implemented in clinical practice.

Methods: We surveyed LAAC-performing centers.

Patterns of Care for Medicare Beneficiaries With Metastatic Prostate Cancer.

Introduction: Therapeutic options for men with metastatic prostate cancer have increased in the past decade. We studied recent treatment patterns for men with metastatic prostate cancer and how treatment patterns have changed over time.

Methods: Using the Surveillance, Epidemiology, and End Results‒Medicare database, we identified fee-for-service Medicare beneficiaries who either were diagnosed with metastatic prostate cancer or developed metastases following diagnosis, as indicated by the presence of claims with diagnoses codes for metastatic disease, between 2007 and 2017.

Health-related quality of life among prostate cancer survivors with metastatic disease and non-metastatic disease and men without a cancer history in the USA.

Background: Few studies have comprehensively compared health-related quality of life (HRQoL) between metastatic prostate cancer survivors, survivors with non-metastatic disease, and men without a cancer history.

Methods: We used the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS) data linkage to identify men aged ≥ 65 years enrolled in Medicare Advantage (MA) plans. Prostate cancer survivors were diagnosed between 1988 and 2017 and completed MHOS surveys between 1998 and 2019.

Cost-Effectiveness Analysis of Screening for Pancreatic Cancer Among High-Risk Populations.

Purpose: We evaluated the potential cost-effectiveness of combined magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) screening for pancreatic ductal adenocarcinoma (PDAC) among populations at high risk for the disease.

Methods: We used a microsimulation model of the natural history of PDAC to estimate the lifetime health benefits, costs, and cost-effectiveness of PDAC screening among populations with specific genetic risk factors for PDAC, including and , , , Lynch syndrome, , , and . For each high-risk population, we simulated 29 screening strategies, defined by starting age and frequency.

Hospital ownership and admission rates from the emergency department, evidence from Florida.

Objective: In light of Department of Justice investigations of for-profit chains for over-admitting patients, we sought to evaluate whether for-profit hospitals are more likely to admit patients from the emergency department.

Data Sources: We used statewide visit-level inpatient and emergency department records from Florida's Agency for Healthcare Administration for 2007-2019.

Study Design: We calculated differences in admission rates between for-profit and other hospitals, adjusting for patient and hospital characteristics.

The cost burden of metastatic prostate cancer in the US populations covered by employer-sponsored health insurance.

Background: Recent advancements in the clinical management of metastatic prostate cancer include several costly therapies and diagnostic tests. The objective of this study was to provide updated information on the cost to payers attributable to metastatic prostate cancer among men aged 18 to 64 years with employer-sponsored health plans and men aged 18 years or older covered by employer-sponsored Medicare supplement insurance.

Methods: By using Merative MarketScan commercial and Medicare supplemental data for 2009-2019, the authors calculated differences in spending between men with metastatic prostate cancer and their matched, prostate cancer-free controls, adjusting for age, enrollment length, comorbidities, and inflation to 2019 US dollars.

The Cost of Metastatic Prostate Cancer in the United States.

Introduction: We sought to estimate per patient and annual aggregate health care costs related to metastatic prostate cancer.

Methods: Using the Surveillance, Epidemiology, and End Results-Medicare database, we identified fee-for-service Medicare beneficiaries ages 66 and older diagnosed with metastatic prostate cancer or claims with diagnosis codes for metastatic disease (indicating tumor progression following diagnosis) between 2007 and 2017. We measured annual health care costs and compared costs between cases and a sample of beneficiaries without prostate cancer.

Employment and Labor Force Participation Among Prostate Cancer Survivors.

Introduction: Diagnosis and treatment of cancer may impair patients' ability to continue to work. We assessed the impact of a prior prostate cancer diagnosis on employment and labor force participation.

Methods: Using the National Health Interview Surveys for 2010 to 2018, we identified sample adults previously diagnosed with prostate cancer aged <65 years (prostate cancer survivors) who were currently or previously employed.

Variation in State-Level Mammography Use, 2012 and 2020.

Objectives: Mammography is a screening tool for early detection of breast cancer. Uptake in screening use in states can be influenced by Medicaid coverage and eligibility policies, public health outreach efforts, and the Centers for Disease Control and Prevention-funded National Breast and Cervical Cancer Early Detection Program. We described state-specific mammography use in 2020 and changes as compared with 2012.

Quality of life and functional limitations in persons with epilepsy.

Objective: Epilepsy can reduce quality of life (QOL), functionality, and social participation, but these effects have not been adequately quantified in large, population-based, controlled studies. We sought to evaluate the impact of epilepsy on patients' QOL and employment outcomes.

Methods: In this cross-sectional study we used nationally representative, pooled data from the Medical Expenditure Panel Survey (MEPS) household component files for 2010-2018.

Cancer Survivorship and Supportive Care Economics Research: Current Challenges and Next Steps.

Background: Rapid growth in the number of cancer survivors raises numerous questions about health and economic outcomes among survivors along with their families, caregivers, and employers. Health economics theory and methods can contribute to many open questions to improve survivorship.

Methods: In this paper, we review key areas where more research is needed and describe strategies for improving data infrastructure, research funding, and capacity building to strengthen survivorship health economics research.

Shared Decision-Making for Implantable Cardioverter-Defibrillators: Policy Goals, Metrics, and Challenges.

Shared decision-making has become a new focus of health policy. Though its core elements are largely agreed upon, there is little consensus regarding which outcomes to prioritize for policy-mandated shared decision-making.

The impact of government-mandated shared decision-making for implantable defibrillators: A natural experiment.

Background: In 2018, the Centers for Medicare and Medicaid Services (CMS) mandated that patients considering implantation of an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death undergo shared decision-making (SDM) using a decision-aid.

Objective: To observe the impact of the CMS's mandate on core measures of SDM using a natural experiment.

Research Design, Subjects, And Measures: Patients who underwent implantation of a primary prevention ICD within the Emory Healthcare system between 2017-2019 (pre and post SDM mandate) were surveyed.

Disparities in magnetic resonance imaging of the prostate for traditionally underserved patients with prostate cancer.

Background: Prebiopsy magnetic resonance imaging (MRI) of the prostate improves detection of significant tumors, while decreasing detection of less-aggressive tumors. Therefore, its use has been increasing over time. In this study, the use of prebiopsy MRI among Medicare beneficiaries with prostate cancer was examined.

The value of new drugs for advanced prostate cancer.

Background: The US Food and Drug Administration has recently approved a number of new cancer drugs. The clinical trials that serve as the basis for new cancer drug approvals may not reflect how the drugs will perform in routine practice and do not measure the impact of the drugs on spending. The authors sought to evaluate the real-world effectiveness and value of drugs recently approved for advanced prostate cancer.

Medicare fee reductions and the overuse of intensity-modulated radiotherapy.

Objective: To estimate the impact of a large Medicare fee reduction for intensity-modulated radiation therapy (IMRT) on its use in prostate and breast cancer patients.

Data Sources/study Setting: SEER-Medicare.

Study Design: We compared trends in the use of IMRT between patients treated in practices directly affected by fee reductions (for prostate cancer, men treated in urology practices that own IMRT equipment; for breast cancer, women treated in freestanding radiotherapy clinics) and patients treated in other types of practices.

Trends in the use of active surveillance and treatments in Medicare beneficiaries diagnosed with localized prostate cancer.

Background: The treatment for men diagnosed with localized prostate cancer has changed over time given the increased attention to the harms associated with over-diagnosis and the development of protocols for active surveillance.

Methods: We examined trends in the treatment of men diagnosed with localized prostate cancer between 2004 and 2015, using the most recently available data from Surveillance, Epidemiology, and End Results Program (SEER)-Medicare. Patients were stratified by Gleason score, age, and race groups.

Deterrence effects of antifraud and abuse enforcement in health care.

Estimates of the benefits of antifraud enforcement in health care typically focus on direct monetary damages. Deterrence effects are acknowledged but unquantified. We evaluate the impact of a Department of Justice investigation of hospitals accused of billing Medicare for unnecessary implantable cardiac defibrillator (ICD) procedures on their use.

US False Claims Act Investigations of Unnecessary Percutaneous Coronary Interventions.

This case-control study assess the association of US False Claims Act investigations of the overuse of PCIs with PCI volumes.

Association of Mandatory-Access Prescription Drug Monitoring Programs With Opioid Prescriptions Among Medicare Patients Treated by a Medical or Hematologic Oncologist.

This cohort study examines the association between prescription drug monitoring program mandates with and without a cancer exemption and the percent of oncologists’ patients with any opioid prescription covered by Medicare Part D.

The eligibility and reach of the national breast and cervical cancer early detection program after implementation of the affordable care act.

Introduction: The uninsured rate declined following passage of the Affordable Care Act in 2010. It is unclear how this decrease affected the size of the population eligible for existing safety net programs. We evaluated trends in the number of women eligible for breast and cervical cancer screening and diagnostic services under the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and the reach of the program.