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Impact of United States Preventive Services Task Force Recommendations on Utilization of Prostate-specific Antigen Screening in Medicare Beneficiaries

Khairnar, Rahul, MS, BPharm*; Mishra, Mark V., MD; Onukwugha, Eberechukwu, PhD, MS*

American Journal of Clinical Oncology: November 2018 - Volume 41 - Issue 11 - p 1069–1075
doi: 10.1097/COC.0000000000000431
Original Articles: Genitourinary

Background: Previous studies assessing the impact of United States Preventive Services Task Force (USPSTF) recommendations on utilization of prostate-specific antigen (PSA) screening have not investigated longer-term impacts of 2008 recommendations nor have they investigated the impact of 2012 recommendations in the Medicare population. This study aimed to evaluate change in utilization of PSA screening, post-2008 and 2012 USPSTF recommendations, and assessed trends and determinants of receipt of PSA screening in the Medicare population.

Methods: This retrospective study of male Medicare beneficiaries utilized Medicare Current Beneficiary Survey data and linked administrative claims from 2006 to 2013. Beneficiaries aged ≥65 years, with continuous enrollment in parts A and B for each year they were surveyed were included in the study. Beneficiaries with self-reported/claims-based diagnosis of prostate cancer were excluded. The primary outcome was receipt of PSA screening. Other measures included age groups (65 to 74 and ≥75), time periods (pre-2008/post-2008 and 2012 recommendations), and sociodemographic variables.

Results: The study cohort consisted of 11,028 beneficiaries, who were predominantly white (87.56%), married (69.25%), and unemployed (84.4%); 52.21% beneficiaries were aged ≥75. Declining utilization trends for PSA screening were observed in men aged ≥75 after 2008 recommendations and in both age groups after 2012 recommendations. The odds of receiving PSA screening declined by 17% in men aged ≥75 after 2008 recommendations and by 29% in men aged ≥65 after 2012 recommendations.

Conclusions: The 2008 and 2012 USPSTF recommendations against PSA screening were associated with declines in utilization of PSA screening during the study period. USPSTF recommendations play a significant role in affecting utilization patterns of health services.

Departments of *Pharmaceutical Health Services Research

Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD

E.O. receives funding from Bayer Healthcare Pharmaceuticals and Pfizer Inc. and consults Novo Nordisk. M.V.M. is a PCORI Patient Engagement Advisory Panel Member. R.K. declares no conflicts of interest.

Reprints: Rahul Khairnar, MS, BPharm, 220 N Arch Street, 12th Floor, Saratoga Office Building, Baltimore, MD 21201. E-mail:

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