Table 4. 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 Medicarea.
| Cascade services | Utilization rate per 100 veterans | Cost per veteran, US$ | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Unadjusted | Unadjusted differenceb | Adjusted difference (95% CI)c | Mean unadjusted | Unadjusted differenced | Adjusted difference (95% CI)c | |||||
| Medicare PSA group (n = 17 981) | VHA PSA group (n = 36 459) | Medicare PSA group (n = 17 981) | VHA PSA group (n = 36 459) | |||||||
| Total | 53.9 | 45.3 | 8.6 | 9.9 (9.7 to 10.1) | 45.1 | 35.0 | 10.1 | 11.9 (7.6 to 16.2) | ||
| Additional PSA test | 20.3 | 18.6 | 1.7 | 2.6 (2.5 to 2.8) | 4.5 | 4.2 | 0.3 | 0.6 (0.5 to 0.6) | ||
| Related outpatient visite | 8.1 | 10.0 | –1.9 | –1.7 (–1.72 to –1.70)f | 6.4 | 7.5 | –1.1 | –1.0 (–1.8 to –0.2) | ||
| Urology visit | 23.2 | 14.2 | 9.0 | 8.9 (8.8 to 9.0) | 18.2 | 10.2 | 8.0 | 8.0 (6.6 to 9.4) | ||
| Prostate imaging | 0.3 | 1.3 | –1.0 | –0.9 (–0.8 to –1.0) | 1.0 | 4.1 | –3.1 | –3.0 (–3.6 to –2.3) | ||
| Prostate biopsy | 0.73 | 0.42 | 0.31 | 0.4 (0.3 to 0.5) | 13.3 | 7.8 | 5.5 | 6.8 (4.1 to 9.5) | ||
| Androgen deprivation therapy | 0.53 | 0.38 | 0.15 | 0.12 (0.06 to 0.19) | 1.2 | 0.9 | 0.3 | 0.3 (–0.1 to 0.7) | ||
| Surgical procedureg | <0.1h | <0.1h | <0.1h | <0.1h | NA | NA | NA | NA | ||
| Radiation therapyi | 0.81 | 0.33 | 0.48 | 0.47 (0.27 to 0.68) | 0.50 | 0.33 | NA | 0.6 (0.2 to 0.9) | ||
Abbreviation: NA, not applicble.
Outcomes identified during 6-month follow-up period.
Determined by subtracting the rate of potential cascade services per 100 veterans among those who received low-value PSA testing within the VHA from those who received low-value PSA testing within Medicare.
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 received low-value PSA testing within the VHA from those who received low-value PSA testing within Medicare.
Outpatient visit or consultation with a primary diagnosis of prostate cancer or elevated PSA.
Consists of 0.8 (95% CI, 0.7 to 1.0) visits for elevated PSA and –2.5 (95% CI, –2.47 to –2.63) 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.