Differential Adoption of Laser Prostatectomy for Treatment of Benign Prostatic Hyperplasia
Schroeck FR, Hollingsworth JM, Hollenbeck BK, Jacobs BL, Suskind AM, Sarma AV, Wei JT. Urology. 2013 Mar 19. pii: S0090-4295(13)00175-1. doi: 10.1016/j.urology.2013.01.051. [Epub ahead of print]

Source

Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan.

Abstract

OBJECTIVE:

To evaluate whether socioeconomic environment affects the adoption of new laser technology for treatment of benign prostatic hyperplasia (BPH).

METHODS:

Using all payer data, we identified all discharges for laser prostatectomy or transurethral resection of the prostate (TURP) performed in Florida (2001-2009). We determined whether or not each of 114 healthcare markets (Hospital Service Areas) offered laser prostatectomy or TURP and assessed the market-level socioeconomic environment using a previously described ZIP code-based summary score. We used generalized estimating equations to examine the association of socioeconomic environment with offering laser prostatectomy or TURP, adjusting for additional market characteristics.

RESULTS:

Better socioeconomic environment was associated with offering laser prostatectomy (odds ratio 1.21 for each 1 point increase in summary score, 95% confidence interval 1.08-1.35, P <.001). Adoption of laser prostatectomy over time was more rapid in markets with superior socioeconomic environment (P <.001 for interaction of socioeconomic summary score with year), such that by study midpoint, 82% of advantaged vs 54% of disadvantaged markets had adopted this new technology. In contrast, socioeconomic environment had only minimal effects on whether or not a market offered TURP.

CONCLUSION:

We found delayed access to new laser technology in more disadvantaged socioeconomic environments, which may translate into disparities in certain outcomes after transurethral surgery for BPH.