Physician Payment Incentives and Active Surveillance in Low-Risk Prostate Cancer

Area of Science:

• Urology
• Health Economics
• Oncology

Background:

• Active surveillance for low-risk prostate cancer is underutilized despite clinical guidelines.
• Reimbursement structures often favor treatment over conservative management, potentially impacting adherence to active surveillance protocols.

Purpose of the Study:

• To evaluate the impact of a novel payment incentive on the adoption of active surveillance in men with low-risk prostate cancer.
• To assess whether financial incentives can promote guideline-concordant care in prostate cancer management.

Main Methods:

• A cohort study analyzed data from 15,273 men with prostate cancer diagnosed between 2015-2021 within the Michigan Urological Surgery Improvement Collaborative (MUSIC).
• The study compared active surveillance adoption rates before and during a payment incentive period (June 2017-September 2018).
• Statistical analyses, including odds ratios, were used to determine the association between the incentive and surveillance uptake.

Main Results:

• The percentage of men with low-risk prostate cancer electing surveillance increased from 54.4% in 2015 to 84.1% in 2021.
• However, the payment incentive was not significantly associated with increased active surveillance adoption during its application (OR, 0.96; 95% CI, 0.75-1.24).
• Secondary analyses also failed to demonstrate a link between the incentive and increased active surveillance.

Conclusions:

• A value-based payment incentive did not lead to greater adoption of active surveillance for low-risk prostate cancer.
• Effective implementation of value-based reimbursement may necessitate customized approaches considering existing policies and practice dynamics to enhance prostate cancer care quality.