Incentives Do Not Boost Prostate Cancer Active Surveillance

TOPLINE:

Active surveillance adoption for low-risk prostate cancer increased from 54% to 84% between 2015 and 2021. A commercial payer’s payment incentive program showed no significant impact on increasing active surveillance rates compared with pre-incentive levels.

METHODOLOGY:

• A cohort study analyzed data from 15,273 men (median age, 65 years) with prostate cancer diagnosed through the Michigan Urological Surgery Improvement Collaborative (MUSIC), a statewide quality improvement initiative.
• Participants included men with newly diagnosed low-risk or low-volume, favorable intermediate-risk prostate cancer eligible for active surveillance.
• A health insurance payment incentive was implemented between June 2017 and September 2018, offering enhanced reimbursement if practices achieved ≥ 72% active surveillance consideration or initiation among low-risk patients.
• Primary outcome measures focused on active surveillance adoption relative to the pre-incentive period among men with low-risk prostate cancer, with secondary analyses examining practice patterns by baseline surveillance use and insurance plan distribution.

TAKEAWAY:

• Active surveillance rates for low-risk prostate cancer increased substantially from 54.4% (729 of 1340 men) in 2015 to 84.1% (1089 of 1295 men) in 2021.
• The payment incentive showed no significant association with increased active surveillance adoption compared with the pre-incentive period (odds ratio [OR], 0.96; 95% CI, 0.75-1.24).
• Practices with the lowest baseline surveillance rates showed reduced odds of surveillance during the incentive period (OR, 0.60; 95% CI, 0.37-0.97; P = .04).
• Among practices with the highest proportion of Blue Cross Blue Shield of Michigan coverage, the payment incentive showed marginally significant association with increased surveillance adoption (OR, 1.56; 95% CI, 1.00-2.43; P = .05).

IN PRACTICE:

“As remuneration for treatment is immediate and generally supersedes that for active surveillance in the first year, incentives through payment policy may encourage adherence to clinical guidelines, thereby improving quality,” wrote the authors of the study.

SOURCE:

The study was led by Arnav Srivastava, MD, MPH, MS, University of Michigan in Ann Arbor. It was published online on January 8 in JAMA Network Open.

LIMITATIONS:

A notable limitation was that 9.4% of patients lacked initial treatment data and were excluded from the main analysis, though sensitivity analyses classifying these patients as either undergoing surveillance or treatment showed similar findings. The increasing adoption of active surveillance both within MUSIC and nationally made it challenging to evaluate the payment incentive’s specific impact, suggesting possible ceiling effects. Previous quality improvement initiatives by MUSIC, including patient and physician education, may have had lasting effects that influenced the results. Additionally, researchers could not distinguish between Blue Cross Blue Shield of Michigan patients covered by Preferred Provider Organization plans vs other plans, limiting precise assessment of the incentive’s impact.

DISCLOSURES:

Srivastava received support through a training grant from the National Cancer Institute. Two other authors of the paper reported disclosures. Brent Hollenbeck, MD, MS, disclosed receiving fees from Elsevier Publishing for professional activities and grant funding from the National Cancer Institute, American Cancer Society, National Institute on Aging, and Agency for Healthcare Research and Quality outside the submitted work. Vahakn Shahinian, MD, reported receiving grant funding from the National Cancer Institute, American Cancer Society, and Agency for Healthcare Research and Quality. Support for the Michigan Urological Surgery Improvement Collaborative was provided by Blue Cross Blue Shield of Michigan as part of their Value Partnerships program.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.