Table 2. Use and Cost of Potential Cascade Services Among US Veterans Who Received Low-Value Prostate-Specific Antigen (PSA) Testing Within the US Veterans Health Administration (VHA) vs Those Who Did Not Receive Low-Value PSA Testinga.
| Cascade service | Utilization rate per 100 veterans | Cost per veteran, US$ | ||||||
|---|---|---|---|---|---|---|---|---|
| Unadjusted | Unadjusted difference in rateb | Adjusted difference in rate (95% CI)c | Mean unadjusted | Unadjusted differenced | Adjusted difference (95% CI)c | |||
| VHA PSA group (n = 36 459) | Control group (n = 245 953) | VHA PSA group (n = 36 459) | Control group (n = 245 953) | |||||
| Total | 45.3 | 14.4 | 30.9 | 31.2 (29.2 to 33.2) | 35.0 | 9.8 | 25.2 | 24.5 (20.8 to 28.1) |
| Additional PSA test | 18.6 | 5.2 | 13.4 | 12.3 (11.3 to 13.3) | 4.2 | 1.2 | 3.0 | 2.8 (2.5 to 3.1) |
| Related outpatient visite | 10.0 | 1.4 | 8.6 | 9.4 (8.4 to 10.5)f | 7.5 | 1.1 | 6.4 | 7.1 (6.1 to 8.1) |
| Urology visit | 14.2 | 7.3 | 6.9 | 7.6 (6.6 to 8.7) | 10.2 | 5.4 | 4.8 | 5.2 (4.1 to 6.3) |
| Prostate imaging | 1.3 | 0.5 | 0.8 | 0.8 (0.7 to 1.0) | 4.1 | 1.3 | 2.8 | 2.9 (2.0 to 3.8) |
| Prostate biopsy | 0.42 | 0.03 | 0.40 | 0.3 (0.2 to 0.4) | 7.8 | 0.5 | 7.3 | 5.6 (4.4 to 6.7) |
| Androgen deprivation therapy | 0.38 | 0.03 | 0.35 | 0.5 (0.3 to 0.6) | 0.9 | 0.4 | 0.5 | 0.6 (0.3 to 0.9) |
| Surgical procedureg | <0.1h | <0.1h | <0.1h | <0.1h | NA | NA | NA | NA |
| Radiation therapyi | 0.33 | 0.04 | 0.29 | 0.3 (0.1 to 0.4) | 0.33 | 0.06 | 0.27 | 0.3 (–0.2 to 0.8) |
Abbreviation: NA, not applicable.
Outcomes identified during the 6-month follow-up period.
Determined by subtracting the rate of potential cascade services per 100 veterans among those who did not receive low-value PSA testing from those who received low-value PSA testing within the VHA.
Adjusted for patient-level and US Department of Veterans Affairs (VA) medical center–level covariates (age, race and ethnicity, VA priority group, driving distance to the nearest VA facility, number of Elixhauser conditions, individual Elixhauser conditions, academic affiliation, facility size, census region, rurality, and complexity level) using inverse probability of treatment weighting.
Determined by subtracting the cost of potential cascade services per veteran among those who did not receive low-value PSA testing from those who received low-value PSA testing within the VHA.
Outpatient visit or consultation with a primary diagnosis of prostate cancer or elevated PSA.
Consists of 4.0 (95% CI, 3.5 to 4.5) visits for elevated PSA and 5.5 (95% CI, 4.7 to 6.2) visits for prostate cancer.
Prostatectomy or surgical resection of the prostate. Cost data not available for surgical procedures.
Cell size suppressed due to Medicare data use agreements.
Contact radiation, beam radiation, insertion of radioactive element, brachytherapy, intraoperative radiation therapy, or plaque radiation of the prostate.