Laws don't curb pricey prostate cancer treatments

Laws meant to prevent the overuse of expensive healthcare services don't stop doctors from using pricey prostate cancer treatments, according to two new studies.

Researchers found doctors used robots and special radiation to treat prostate cancer regardless of whether their area had laws requiring government approval before money is spent on healthcare facilities and new equipment.

"Certificate of need laws were designed to align public need with use of different services," said Dr. Bruce Jacobs, a lead author of one of the studies from the University of Michigan in Ann Arbor.

The U.S. government required states to implement the laws in the 1970s and early 1980s, but stopped a few decades ago. Still, some states continue to use the laws in an effort to control costs.

In each study, the researchers looked at treatments for prostate cancer, which is the most common cancer in American men.

The American Cancer Society estimates that one in every six men will be diagnosed with prostate cancer in their lifetime, but most will not die from it. Past research found that many men's prostate cancer is slow-growing, and most are candidates for active surveillance or "watchful waiting."

In Jacobs's study, the researchers looked at whether states with strict laws - those that require approval for even low-cost equipment - used robotic surgery to remove fewer prostates than states with less strict or no laws.

Jacobs and his colleagues write in The Journal of Urology that the price of such robots, and the questions surrounding whether or not robotic surgery to remove a prostate is better than the old-fashioned way should make it an "ideal target" for review under the laws.

In September, for example, one of the studies that have questioned the usefulness of robotic surgery found that men who had robotic surgery ended up having fewer short-term complications, but questioned its long-term benefits and whether the hefty price tag of $1.5 million in startup costs is worth it. (see Reuters Health article of Sep. 12, 2012:)

But another recent study found robotic surgery led to fewer complications, fewer readmissions to the hospital, and fewer deaths due to surgery than traditional methods, according to Intuitive Surgical, the maker of the da Vinci Surgical System.

"That is significant for the patient and for reducing overall costs to the system," wrote Angela Wonson, a spokesperson for Intuitive Surgical, in an email to Reuters Health.

Overall, in the new study, the use of robotic surgery to remove prostates in Medicare patients increased regardless of whether there were strict, less strict or no laws in place. Also, the chance a surgeon used robots had nothing to do with the laws.

RADIATION AND COSTS

A second study by another group of researchers looked at whether the laws limited the use of intensity modulated radiation therapy (IMRT) or slowed the growth of healthcare costs related to prostate cancer.