Do insurance payor type and race predict decreased access to holmium laser enucleation of the prostate? a nationwide analysis of academic centers

You have accessJournal of UrologyCME1 Apr 2023MP21-09 DO INSURANCE PAYOR TYPE AND RACE PREDICT DECREASED ACCESS TO HOLMIUM LASER ENUCLEATION OF THE PROSTATE? A NATIONWIDE ANALYSIS OF ACADEMIC CENTERS Gabriela Gonzalez, Ifeanyi Oyenji, Blythe Durbin-Johnson, Noah Canvasser, Jennifer Anger, and Eric Kurzrock Gabriela GonzalezGabriela Gonzalez More articles by this author , Ifeanyi OyenjiIfeanyi Oyenji More articles by this author , Blythe Durbin-JohnsonBlythe Durbin-Johnson More articles by this author , Noah CanvasserNoah Canvasser More articles by this author , Jennifer AngerJennifer Anger More articles by this author , and Eric KurzrockEric Kurzrock More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003246.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recent literature supports that holmium laser enucleation of the prostate (HoLEP), compared to traditional transurethral procedures, has improved outcomes in hemostasis, urinary symptoms, and complication rates. This study sought to evaluate the utilization of HoLEP and thulium laser enucleation of the prostate (ThuLEP) and associated patient characteristics. METHODS: The Clinical Practice Solutions Center (CPSC) database was queried to identify patients with BPH treated surgically from 2018 to 2022. Men 40 years or older who had procedural intervention for BPH based upon ICD-10 and CPT codes specific to HoLEP, ThuLEP, transurethral resection of the prostate (TURP), laser vaporization, laser coagulation, transurethral incision, microwave thermotherapy, radiofrequency thermotherapy, water vapor thermotherapy, and prostatic urethral lift surgeries. Men with a diagnosis of prostate cancer were excluded. Patient characteristics were analyzed, including age, race, insurance, and region. RESULTS: The analysis included data from 88 academic centers. A total of 63,145 patients underwent surgery, of which 42.4% had a TURP versus 19.8% had a HoLEP/ThuLEP performed. Regionally, patients in the Midwest had a significantly higher probability of receiving HoLEP/ThuLEP. The racial/ethnic demographics of the study population included: 58.8% White, 10.6% Black, 3.6% Hispanic, 2.2% Asian, 0.8% Native or Alaskan Native Americans, and 24% other/unknown patients. A relative risk model comparing the probability of undergoing HoLEP/ThuLEP between races demonstrated that white patients were more likely to undergo laser enucleation compared to any other group except Hispanic patients (Table 1). Commercially insured patients had a 65% higher chance of undergoing a HoLEP/ThuLEP than Medicaid patients. Medicare beneficiaries compared to Medicaid were 83% more likely and 11% more likely than commercially insured patients to have a laser enucleation surgery performed. CONCLUSIONS: Medicaid insurance and non-White race/ethnicity were associated with significantly less utilization of HoLEP. Work needs to be done to decrease the evident disparities in provision of this cutting-edge urologic procedure as differences may be due to counseling or regional access. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e288 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gabriela Gonzalez More articles by this author Ifeanyi Oyenji More articles by this author Blythe Durbin-Johnson More articles by this author Noah Canvasser More articles by this author Jennifer Anger More articles by this author Eric Kurzrock More articles by this author Expand All Advertisement PDF downloadLoading ...