Medical Spending Across Specialties: Urology's Contribution to Financial Toxicity

Noting that a significant proportion of patient spending can be attributed to prescribed medications, Spencer Liem, MD, from the Columbia University Division of Urology at Mount Sinai Medical Center, and other researchers conducted an analysis of surgical specialties and their overall contribution to total Medicare Part D (MPD) costs.

They determined that urologists contributed most significantly to MPD medication costs relative to other specialties. “This is likely caused by high-cost medications for urologic cancer care and contributes to the high proportion of MPD spending,” suggested Dr. Liem. The study report was presented at the 22nd Annual Meeting of the Society of Urology and Oncology.

The study collected MDP beneficiaries, claims, and drug cost data for 106,011 prescribers, of which 9,944 were urologists. Approximately 72% (7,121/9,944) of urologists in the study were identified as high-cost prescribers, defined as annual drug costs in the top quartile, which was the highest percentage among all specialties. The specialties with the next highest proportions were ophthalmology at 69% (12,780/18,462) and gynecology at 14% (3,251/23,774).

MDP data supported the results of multivariable analysis, which indicated urologists were more likely to be high-cost prescribers (odds ratio [OR] = 49.0; 95% confidence interval [CI] 45.03–53.21; p < 0.01). Geographically, surgeons located in the Northeast, Southeast, Pacific-West, and Southwest regions were more likely to be high-cost prescribers compared to those in the Midwest.

“Given the significant effects of financial toxicity on health-related quality of life, further investigation is needed to determine methods to reduce spending while optimizing patient outcomes,” Dr. Liem concluded.