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Regional Variation in Penile Prosthesis Utilization among Medicare Patients with Erectile Dysfunction
Michael E Rezaee1, Briana Goddard2, Ricardo M Munarriz3
1Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH.
Penile prosthesis surgery rates declined in Medicare beneficiaries with erectile dysfunction (ED). Significant regional differences in surgery utilization were found, influenced by urologist density and patient location.
Area of Science:
- Urology
- Health Services Research
Background:
- Erectile dysfunction (ED) affects a significant number of men, with penile prosthesis surgery being a treatment option.
- Understanding the utilization patterns and regional variations in penile prosthesis surgery is crucial for healthcare planning.
Purpose of the Study:
- To characterize the utilization of penile prosthesis surgery among Medicare beneficiaries in the United States.
- To assess and analyze regional differences in the rates of penile prosthesis implantation.
Main Methods:
- Analysis of penile prosthesis surgeries (inflatable and semirigid) in Medicare beneficiaries diagnosed with ED from 2006 to 2014.
- Calculation of adjusted utilization rates per 1000 beneficiaries, accounting for age and race.
- Examination of utilization rates nationally and by hospital referral region (HRR), with adjustments for urology provider density.
Main Results:
- A national decline in adjusted penile prosthesis surgery rates was observed, from 5.41/1000 in 2006 to 3.74/1000 in 2014.
- A substantial 12-fold regional variation in surgery rates was noted in 2014, ranging from 1.9/1000 to 24.2/1000 beneficiaries.
- Adjusting for urology provider density reduced the observed regional variation, indicating provider distribution as a contributing factor.
Conclusions:
- Penile prosthesis surgery utilization is decreasing among Medicare beneficiaries with ED.
- Significant regional disparities in surgery rates exist, potentially explained by urologist and patient factors like provider density.
- Access to and utilization of penile prosthesis surgery is strongly influenced by geographic location and healthcare seeking patterns.
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