Cost implications and complications of overtreatment of XXXX in the United States.

@entity1 @entity1442 @entity137 @entity263
BACKGROUND: Evidence-based consensus guidelines recommend only observation for @entity1 with @entity263 and life expectancy less than 10 years. This report describes the incidence, drivers, cost, and morbidity of overtreatment of @entity263 within the United States. METHODS: The SEER-Medicare Program was used to identify 11,744 @entity1 aged 66 years or older diagnosed with @entity263 in 2004 through 2007. Overtreatment of @entity263 was defined as definitive treatment of a @entity1 with a life expectancy of less than 10 years. Expected survival was estimated using NCCN methodology. Costs were the amount paid by Medicare in years after minus year before diagnosis. @entity137 were relevant Medicare diagnoses/interventions. P values are 2-sided. RESULTS: Of 3001 @entity1 with @entity263 and a life expectancy of less than 10 years, 2011 @entity1 (67%) were overtreated. On multivariable logistic regression, overtreated @entity1 were more likely to be married (odds ratio [OR], 1.29; 95% CI, 1.05-1.59; P=.02), reside in affluent regions (P<.001), and harbor more @entity1442 at diagnosis (P<.001). Two-year @entity137 was greater in overtreated @entity1 (P<.001). Relative to active surveillance/watchful waiting/observation, the median additional cost per definitive treatment was  18,827 over 5 years; the cumulative annual cost attributable to overtreatment in the United States was  58.7 million. The ability to avoid treating the 80% of @entity1 with low-grade disease who will never die of @entity263 would save  1.32 billion per year nationally. CONCLUSIONS: Overtreatment of @entity263 is partially driven by sociodemographic factors and occurs frequently, with marked impact on @entity1 quality of life and health-related costs.
