Regional Variation in Penile Prosthesis Implantation among Medicare Patients Diagnosed with Erectile Dysfunction
Michael Rezaee, MD, MPH1, Briana Goddard, BA1, Ricardo M. Munarriz, MD, MPH2, Martin S. Gross, MD1
1Dartmouth-Hitchcock Medical Center, Lebanon, NH, 2Boston Medical Center, Boston, MA
BACKGROUND: Erectile dysfunction (ED) is a common and costly urologic condition with increasing prevalence as men age. Penile prosthesis implantation is an effective surgical treatment option for ED and is associated with high rates of patient and partner satisfaction. To date, limited research has been conducted to understand penile prosthesis utilization. The purpose of this study was to characterize penile prosthesis utilization and assess for regional variation in the use of this procedure in Medicare beneficiaries across the United States.
METHODS: We examined penile prosthesis utilization (inflatable and semi-rigid implants) in Medicare beneficiaries with a diagnosis of ED for the years 2004 and 2014, the latter being the last year of complete International Classification of Disease, Ninth Revision data available. Adjusted utilization rates were calculated per 1000 beneficiaries accounting for age and race. Utilization rates were examined nationally and by hospital referral region (HRR).
RESULTS: The national adjusted rate of penile prosthesis utilization was 5.0 and 3.7 per 1000 beneficiaries in 2004 and 2014, respectively. In 2014, 1,083,176 Medicare beneficiaries had a diagnosis of ED. Significant variation was found in penile prosthesis utilization; up to a 12-fold difference was observed between HRRs (1.9/1000 in Norfolk, VA to 24.2/1000 in Miami, FL). Over 65% of HRRs performed zero or < 11 penile prosthesis surgeries per year and were censored from the study. The adjusted rate of penile prosthesis utilization was highest among men age 65 to <70 (4.6 per 1000) and lowest among men greater than age 85 (0.9 per 1000).
CONCLUSIONS: Significant regional differences exists in the utilization of penile prostheses among Medicare beneficiaries, up to a 12-fold difference was found in our study. This variance may be explained by a combination of demand, urologist availability, and patient-specific factors. Additionally, over two-thirds of U.S. hospital referral regions perform few to zero implants per year. Penile prosthesis implantation in Medicare beneficiaries with ED likely depends on where these patients receive their urologic care.
Back to 2019 Abstracts