Commercial Prices for Prostatectomy and Treatment among Younger, Privately Insured Men with Prostate Cancer.

Consensus is lacking about whether or how to treat men with prostate cancer, making it susceptible to nonclinical factors. The extent to which financial incentives afforded through differences in commercial prices for prostatectomy are associated with use of treatment, and prostatectomy in particular, is unknown. MarketScan® data were used to identify 38,863 privately insured men aged 64 years or younger diagnosed with prostate cancer between 2010 and 2016. Commercial prices for prostatectomy, defined by professional payments to urologists, were aggregated to the market level. Multivariable logistic regression was used to measure the association of commercial prices for prostatectomy and the use of treatment. The adjusted use of treatment decreased from 87.1% for men diagnosed in 2010 to 71.1% for those diagnosed in 2016 (p <0.01 for trend). Among the treated, prostatectomy was the most common modality every year (eg 71.1% for those diagnosed in 2016). For every $1,000 increase in commercial prices, the adjusted odds of undergoing treatment decreased by 7% (OR 0.93, 95% CI 0.89-0.97, p <0.01). Among the treated, commercial prices were not significantly associated with use of prostatectomy (OR 0.99 for every $1,000 increase, 95% CI 0.89-1.10, p=0.85). Higher commercial prices for prostatectomy were associated with decreased use of treatment. The use of prostatectomy was not associated with its commercial prices.