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Lee AJ, Campbell T, Ceraolo CA, Saxton A, Quarrier SO, Bandari J. The Changing Roles of Urologists, Radiologists, and Advanced Practice Providers in Uroradiology Procedures. Urol Pract 2024; 11:228-235. [PMID: 37903750 DOI: 10.1097/upj.0000000000000482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/13/2023] [Indexed: 11/01/2023]
Abstract
INTRODUCTION Urology has seen shifts in the management of many urologic conditions with the advent of noninvasive procedures that rely on multidisciplinary radiological modalities. This study seeks to analyze changes in urologists, radiologists, and advanced practice providers (APPs) performing uroradiology procedures over time. METHODS The Centers for Medicare & Medicaid Services Physician/Procedure Summary data from 2010 to 2021 were utilized to examine uroradiology Current Procedural Terminology codes billed by urologists, radiologists, and APPs. Percent of total reimbursement and higher volume procedure count (after excluding providers with <11 procedures by per year) by each provider field was calculated and analyzed for changes in distribution from 2010 to 2021. RESULTS There were significant changes in all procedures when examining procedure reimbursement distribution in 2010 to 2021 (P < .001). During the period, urology saw decreases in reimbursement proportion as large as 28.7% for kidney cryoablation and increases as large as 14.2% for nephrostomy tube removals. Radiology saw the largest decreases in reimbursement proportion with an 18.9% decrease for nephrostograms, while the largest increase was 23.6% for suprapubic tube placements. APPs saw the largest increase in suprapubic tube changes reimbursement proportion, which rose 14.2% from 2010 to 2021. There were significant changes in proportion in all procedures, except for antegrade stent, renal cryoablation, renal biopsy, and renal thermoablation. CONCLUSIONS Uroradiology procedures have seen shifts in the distribution of which provider type performs each procedure. Most large changes in reimbursement and procedure proportion were shifted between urology and radiology, with APPs seeing smaller changes.
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Affiliation(s)
- Austin J Lee
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Timothy Campbell
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Carl A Ceraolo
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Aaron Saxton
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Scott O Quarrier
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Jathin Bandari
- Department of Urology, University of Rochester Medical Center, Rochester, New York
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Doersch KM, Tabayoyong WB, Bandari J. Evaluation of toxicities for intravesical drugs in phase 1 bladder cancer trials. Cancer 2023; 129:39-48. [PMID: 36262086 DOI: 10.1002/cncr.34508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Improving clinical trial design is important for optimizing approval of safe and effective drugs. Phase 1 clinical trials seek to determine phase 2 doses by investigating predefined dose-limiting toxicities. Traditional definitions of dose-limiting toxicity may not be applicable to intravesical therapies for bladder cancer. This study compared the frequency of dose-limiting toxicities and serious adverse events in bladder cancer trials for intravesical therapies to other routes of administration. METHODS Studies were abstracted from ClinicalTrials.gov and reconciled with a PubMed search. Primary and secondary end points were predefined before data abstraction, and the primary end point was subject-level dose-limiting toxicity rate. Fisher exact tests were performed with p < .05 designated as significant. RESULTS Eighteen intravesical studies and 24 studies with other routes of administration (the per os/intravenous/intramuscular [PO/IV/IM] group) were identified. Dose-limiting toxicities were reported in 38.9% of intravesical studies, affecting 3.29% of subjects, compared with 30.0% of PO/IV/IM studies representing 4.19% of subjects (p = .52 for study-level and p = .60 for subject-level comparisons). Serious adverse events occurred in 53.9% of intravesical studies in 10.3% of subjects versus 91.0% of studies reporting serious adverse events affecting 41.4% of subjects in the PO/IV/IM group (p = .03 for subject-level and p < .0001 for study-level comparisons). CONCLUSIONS There was no difference in subject-level dose-limiting toxicity rate between intravesical and PO/IV/IM bladder cancer trials. The serious adverse event rate was lower in the intravesical group. Heterogeneity of dose-limiting toxicity definition may affect interpretation of toxicity in phase 1 bladder cancer clinical trials studying different routes of administration. LAY SUMMARY Bladder cancer is a common cancer type that may be treated with therapies that are instilled into the bladder and act locally, called intravesical therapies. This study used publicly available regulatory data from early phase clinical trials to determine whether measures of tolerability used in clinical trials are applicable to intravesical therapies for bladder cancer.
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Affiliation(s)
- Karen M Doersch
- Department of Urology, University of Rochester, Rochester, New York, USA
| | | | - Jathin Bandari
- Department of Urology, University of Rochester, Rochester, New York, USA
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Jones CA, Pekala KR, Armann KM, Maganty A, Yabes JG, Bandari J, Yu M, Davies BJ, Jacobs BL. Opioid-Free Ureteroscopy: Are Academic Urologists Lagging Behind Private Practice? Urology 2022; 167:56-60. [PMID: 35780945 DOI: 10.1016/j.urology.2022.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/11/2022] [Accepted: 06/05/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To examine overall trends in opioid prescribing after ureteroscopy and compared opioid use between private and academic practice settings. We also analyzed the potential for spillover effect from an unrelated opioid-reduction initiative for major oncologic surgery. METHODS We conducted a retrospective chart review of all ureteroscopies performed within our system at four distinct time points from 2016-2019. We recorded the type and number of opioid pills prescribed and calculated oral morphine equivalents. Analysis included comparison between community and academic hospitals as well as pre- and post-initiative. RESULTS 555 patients undergoing ureteroscopy and 29 attending surgeons were included in the analysis. The median prescription size per ureteroscopy decreased throughout the study period in both the private and academic settings. From 2016-2017, median oral morphine equivalents (OMEs) decreased from 60 to 0 in the private setting and remained at 0 for the duration of the study period. Opioid reduction in the academic setting lagged behind private practitioners but median OMEs did steadily decrease to 0 in 2019. No significant spillover effect was observed. CONCLUSION Since 2016, opioid prescribing following ureteroscopy has decreased in both the private and academic practice settings. Notably, private practice urologists achieved a median of 0 opioids 2 years prior to academic urologists. These data suggest that, in some circumstances, academic institutions may have been slower to respond to the opioid epidemic.
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Affiliation(s)
| | | | - Kody M Armann
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Jonathan G Yabes
- Center for Research on Health Care, Pittsburgh, PA; UPMC Division of General Internal Medicine, Pittsburgh, PA
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Bandari J, Zummo J, Belani K, Brown E, Metcalf M, Nanayakkara N. Phase 1a/b safety study of intravesical instillation of TARA-002 in adults with high-grade non-muscle invasive bladder cancer (ADVANCED-1). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps4620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS4620 Background: Bladder cancer is the most common malignancy involving the urinary system, resulting in approximately 18,000 deaths each year in the US. Approximately 70% of new urothelial bladder cancer cases are classified as non-muscle invasive bladder cancer (NMIBC). With the current Bacillus Calmette-Guérin (BCG) shortage and limited effective alternate therapies, there continues to be a significant unmet need for treatment options for patients with NMIBC. TARA-002 is being developed for the treatment of high-grade (HG) NMIBC (consisting of HG Ta, T1, and carcinoma in situ [CIS]). TARA-002 is a lyophilized biological preparation for instillation containing cells of Streptococcus pyogenes (Group A, type 3) Su strain treated with benzylpenicillin. TARA-002 is manufactured using the same master cell bank as OK-432 (Picibanil) and is approved in Japan and Taiwan for the treatment of several oncology indications. Nonclinical toxicology studies with TARA-002 and nonclinical and clinical studies with OK-432 (a comparable product to TARA-002) support the starting dose for the planned Phase 1a/b study. Methods: ADVANCED-1 is a Phase 1a/b, dose finding, open-label study of intravesical instillation of TARA-002 in adults with HG NMIBC. The study includes a dose escalation phase (Phase 1a) and a dose expansion phase (Phase 1b). The objective of the study is to evaluate the safety and tolerability of TARA-002, to establish the maximum tolerated dose (MTD) and recommended Phase 2 dose (RP2D) in the treatment of subjects with HG Ta or CIS ± Ta NMIBC during Phase 1a, and to further assess the safety and preliminary efficacy of TARA-002 in the treatment of subjects with CIS NMIBC with active disease during Phase 1b. For this first-in-human study, stage T1 is excluded. The study includes eligible male and female subjects ≥ 18 years of age who are unable to obtain BCG or have received at least one dose of intravesical BCG or chemotherapy. Those with current or a history of penicillin allergy or current evidence of any condition, therapy, or laboratory abnormality that might confound the results are excluded. The overall study duration for each subject includes 28 days of screening period, 6-week treatment period, and 6-week follow-up period. During the dose escalation phase (1a), up to 18 subjects with HG Ta or CIS ± Ta NMIBC are enrolled. Up to 3 dose levels are tested sequentially with 6 weekly intravesical doses, starting with the lowest dose using a 3+3 design in a dose escalation manner. At the established RP2D, the dose expansion phase (1b) will enroll approximately 12 new subjects with CIS ± Ta NMIBC with active disease and treat in the same manner to further assess the safety and preliminary efficacy of TARA-002. Phase 1a is currently open for enrollment. Clinical trial information: NCT05085977; NCT05085990.
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Pekala KR, Yabes JG, Bandari J, Yu M, Davies BJ, Sabik LM, Kahn JM, Jacobs BL. Corrigendum to ‘The centralization of bladder cancer care and its implications for patient travel distance’ [Urologic Oncology: Seminars and Original Investigations volume 39 (2021) 834.e.9–834.e.20/9680]. Urol Oncol 2022; 40:203-206. [DOI: 10.1016/j.urolonc.2021.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Saba P, Melnyk R, Holler T, Oppenheimer D, Schuler N, Tabayoyong W, Bloom J, Bandari J, Frye T, Joseph J, Weinberg E, Hollenberg G, Ghazi A. Comparison of Multi-Parametric MRI of the Prostate to 3D Prostate Computer Aided Designs and 3D-Printed Prostate Models for Pre-Operative Planning of Radical Prostatectomies: A Pilot Study. Urology 2021; 158:150-155. [PMID: 34496263 DOI: 10.1016/j.urology.2021.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/11/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the use of 3D computed aided designs and 3D-printed models as pre-operative planning tools for urologists, in addition to radiologist interpreted mp-MRIS, prior to radical prostatectomy procedures. METHODS Ten patients with biopsy-positive lesions detected on mp-MRI were retrospectively selected. Radiologists identified lesion locations using a Prostate Imaging-Reporting and Data System (PI-RADS) map and segmented the prostate, lesion(s), and surrounding anatomy to create 3D-CADs and 3D-printed models for each patient. 6 uro-oncologists randomly reviewed three modalities (mp-MRI, 3D-CAD, and 3D-printed models) for each patient and identified lesion locations which were graded for accuracy against the radiologists' answers. Questionnaires assessed decision confidence, ease-of-interpretation, and usefulness for preoperative planning for each modality. RESULTS Using 3D-CADs and 3D-printed models compared to mp-MRI, urologists were 2.4x and 2.8x more accurate at identifying the lesion(s), 2.7x and 3.2x faster, 1.6x and 1.63x more confident, and reported it was 1.6x and 1.7x easier to interpret. 3D-CADs and 3D-printed models were reported significantly more useful for overall pre-operative planning, identifying lesion location(s), determining degree of nerve sparing, obtaining negative margins, and patient counseling. Sub-analysis showed 3D-printed models demonstrated significant improvements in ease-of-interpretation, speed, usefulness for obtaining negative margins, and patient counseling compared to 3D-CADs. CONCLUSION 3D-CADs and 3D-printed models are useful adjuncts to mp-MRI in providing urologists with more practical, accurate, and efficient pre-operative planning.
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Affiliation(s)
- Patrick Saba
- University of Rochester Medical Center, Department of Urology, Simulation Innovation Laboratory, Rochester, New York
| | - Rachel Melnyk
- University of Rochester Medical Center, Department of Urology, Simulation Innovation Laboratory, Rochester, New York
| | - Tyler Holler
- University of Rochester Medical Center, Department of Urology, Simulation Innovation Laboratory, Rochester, New York
| | - Daniel Oppenheimer
- University of Rochester Medical Center, Department of Imaging Sciences, Rochester, New York
| | - Nathan Schuler
- University of Rochester Medical Center, Department of Urology, Simulation Innovation Laboratory, Rochester, New York
| | - William Tabayoyong
- University of Rochester Medical Center, Department of Urology, Rochester, New York
| | - Jonathan Bloom
- University of Rochester Medical Center, Department of Urology, Rochester, New York
| | - Jathin Bandari
- University of Rochester Medical Center, Department of Urology, Rochester, New York
| | - Thomas Frye
- University of Rochester Medical Center, Department of Urology, Rochester, New York
| | - Jean Joseph
- University of Rochester Medical Center, Department of Urology, Rochester, New York
| | - Eric Weinberg
- University of Rochester Medical Center, Department of Imaging Sciences, Rochester, New York
| | - Gary Hollenberg
- University of Rochester Medical Center, Department of Imaging Sciences, Rochester, New York
| | - Ahmed Ghazi
- University of Rochester Medical Center, Department of Urology, Simulation Innovation Laboratory, Rochester, New York.
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Pekala KR, Yabes JG, Bandari J, Yu M, Davies BJ, Sabik LM, Kahn JM, Jacobs BL. The centralization of bladder cancer care and its implications for patient travel distance. Urol Oncol 2021; 39:834.e9-834.e20. [PMID: 34162498 DOI: 10.1016/j.urolonc.2021.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/16/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the impact of centralized surgical and nonsurgical care (i.e., radiation and chemotherapy) on travel distances and survival outcomes for patients with advanced bladder cancer. Bladder cancer is a disease with high mortality for which treatment access is paramount and survival is superior in patients receiving surgery at high-volume centers. METHODS Using SEER-Medicare, we identified patients 66 years or older diagnosed with bladder cancer between 2004-2013. We categorized patients as treated with either surgical (i.e., radical cystectomy) or nonsurgical (i.e., radiation or chemotherapy) care. We fit a linear probability model to generate the predicted proportion of patients treated at the top quintile of volume over time and assessed travel distance, 1-year all-cause mortality, and 1-year bladder cancer-specific mortality over time. RESULTS A total of 6,756 and 10,383 patients underwent surgical and nonsurgical care, respectively. The percentage of patients treated at high-volume centers increased over the study period for both surgical care (53% to 62%) and nonsurgical care (47% to 55%), (both P< 0.001). Median travel distance increased (11.8 to 20.3 miles) for surgical care and (6.5 to 8.3 miles) for nonsurgical care, (both P < 0.001). The 1-year adjusted all-cause mortality and 1-year adjusted bladder-cancer specific mortality decreased significantly for both surgical and nonsurgical care (both P < 0.05). CONCLUSIONS Over time, centralization of surgical and nonsurgical care for bladder cancer patients increased, which was associated with increasing patient travel distance and decreased all-cause and bladder-cancer specific mortality.
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Affiliation(s)
| | - Jonathan G Yabes
- Center for Research on Health Care; Division of General Internal Medicine, Department of Medicine
| | | | | | | | - Lindsay M Sabik
- Center for Research on Health Care; Department of Health Policy and Management, Graduate School of Public Health
| | - Jeremy M Kahn
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Bruce L Jacobs
- Department of Urology; Center for Research on Health Care
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Abstract
Over the last two decades, robotic surgery has become a mainstay in hospital systems around the world. Leading this charge has been Intuitive Surgical Inc.’s da Vinci robotic system (Sunnyvale, CA, USA). Through its innovative technology and unique revenue model, Intuitive has installed 4,986 robotic surgical systems worldwide in the last two decades. The rapid rate of adoption and diffusion of the surgical robot has been propelled by many important industry-specific factors. In this review, we propose a model that explains the successful adoption of robotic surgery due to its three core groups: the surgeon, the hospital administrator, and the patient.
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Affiliation(s)
- Anup A Shah
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jathin Bandari
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Daniel Pelzman
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Benjamin J Davies
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Jacobs BL, Rogers D, Yabes JG, Bandari J, Ayyash OM, Maganty A, Armann KM, Worku HA, Pace NM, Shah A, Pekala KR, Yu M, Chelly JE, Macleod LC, Davies BJ. Large reduction in opioid prescribing by a multipronged behavioral intervention after major urologic surgery. Cancer 2020; 127:257-265. [PMID: 33002197 DOI: 10.1002/cncr.33200] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/15/2020] [Accepted: 06/04/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Surgeons play a pivotal role in combating the opioid crisis that currently grips the United States. Changing surgeon behavior is difficult, and the degree to which behavioral science can steer surgeons toward decreased opioid prescribing is unclear. METHODS This was a single-institution, single-arm, pre- and postintervention study examining the prescribing of opioids by urologists for adult patients undergoing prostatectomy or nephrectomy. The primary outcome was the quantity of opioids prescribed in oral morphine equivalents (OMEs) after hospital discharge. The primary exposure was a multipronged behavioral intervention designed to decrease opioid prescribing. The intervention had 3 components: 1) formal education, 2) individual audit feedback, and 3) peer comparison performance feedback. There were 3 phases to the study: a pre-intervention phase, an intervention phase, and a washout phase. RESULTS Three hundred eighty-two patients underwent prostatectomy, and 306 patients underwent nephrectomy. The median OMEs decreased from 195 to 19 in the prostatectomy patients and from 200 to 0 in the nephrectomy patients (P < .05 for both). The median OMEs prescribed did not increase during the washout phase. Prostatectomy patients discharged with opioids had higher levels of anxiety than patients discharged without opioids (P < .05). Otherwise, prostatectomy and nephrectomy patients discharged with and without opioids did not differ in their perception of postoperative pain management, activity levels, psychiatric symptoms, or somatic symptoms (P > .05 for all). CONCLUSIONS Implementing a multipronged behavioral intervention significantly reduced opioid prescribing for patients undergoing prostatectomy or nephrectomy without compromising patient-reported outcomes.
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Affiliation(s)
- Bruce L Jacobs
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Devin Rogers
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jonathan G Yabes
- Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jathin Bandari
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Omar M Ayyash
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Avinash Maganty
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kody M Armann
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hermoon A Worku
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Natalie M Pace
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anup Shah
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kelly R Pekala
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michelle Yu
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jacques E Chelly
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Liam C Macleod
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Benjamin J Davies
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Shah AA, Kumar P, Ogunmola AG, Ayyash O, Yabes JG, Sabik LM, Odisho AY, Bandari J, Macleod LC, Davies BJ, Jacobs BL. Statewide Price Variation for Generic Benign Prostatic Hyperplasia Medications. Urology 2020; 148:224-229. [PMID: 32961225 DOI: 10.1016/j.urology.2020.08.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/26/2020] [Accepted: 08/31/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the geographic and pharmacy-type variation in costs for generic benign prostatic hyperplasia (BPH) medications in order to improve drug price transparency and reduce health disparities. Medical therapy for BPH can be expensive, having significant implications for uninsured and underinsured patients. METHODS We generated a 20% random sample of all pharmacies in Pennsylvania and queried each for the uninsured cash price of a 30-day prescription of tamsulosin 0.4mg daily, finasteride 5mg daily, oxybutynin immediate release 5mg TID and oxybutynin XL 10mg daily. Our primary objectives were to identify price variation based on pharmacy type (i.e., big chain and independent) and between geographic regions (predetermined by the Pennsylvania Health Care Cost Containment Council Database). We fit multivariable quantile regression models to test for an association between drug price and region after controlling for pharmacy type. RESULTS Among 575 retail pharmacies contacted, 473 responded (82% response rate). The median cash price was significantly higher for big chain pharmacies than for independent pharmacies for tamsulosin ($66 vs. $15), finasteride ($68 vs. $15), oxybutynin immediate release ($49 vs. $35), and oxybutynin XL ($79 vs. $31) (all p < 0.05). When controlling for region, the median and 75th percentile price of all drugs was significantly higher for big chain pharmacies. When controlling for pharmacy type, regional variation was noted in all four drugs at the 75th percentile price and was greater for independent pharmacies. CONCLUSION Compared to independent pharmacies, big chain pharmacies charged significantly more for generic BPH medications to uninsured patients. However, independent pharmacies demonstrated more regional variation in their pricing.
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Affiliation(s)
- Anup A Shah
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Praveen Kumar
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
| | | | - Omar Ayyash
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Jonathan G Yabes
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
| | - Lindsay M Sabik
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
| | - Anobel Y Odisho
- Department of Urology, School of Medicine, University of California, San Francisco, CA.
| | - Jathin Bandari
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Liam C Macleod
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Benjamin J Davies
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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Grajales V, Bandari J, Hale NE, Yabes JG, Turner RM, Fam MM, Sabik LM, Gingrich JR, Davies BJ, Jacobs BL. Associations Between Female Sex and Treatment Patterns and Outcomes for Muscle-invasive Bladder Cancer. Urology 2020; 151:169-175. [PMID: 32673679 DOI: 10.1016/j.urology.2020.06.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/17/2020] [Accepted: 06/28/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the association of female sex with the selected treatment for patients with nonmetastatic muscle-invasive bladder cancer. Sex is a known independent predictor of death from bladder cancer. A potential explanation for this survival disparity is difference in treatment pattern and stage presentation among males and females. MATERIALS AND METHODS Using the surveillance, epidemiology, and end results-medicare data set, we identified 6809 patients initially diagnosed with nonmetastatic muscle-invasive bladder cancer between 2004 and 2014. We fit multivariable logistic regression and Cox models to assess the relationship of sex with treatment modality and survival adjusting for differences in patient characteristics. RESULTS Of the 6809 patients with nonmetastatic muscle invasive bladder cancer, 2528 (37%) received a radical cystectomy while 4281 (63%) received an alternative bladder sparing intervention. Women were significantly more likely to receive a cystectomy (odds ratios [OR] 1.39; 95% confidence intervals [CI] 1.20-1.61), present at an older age with less comorbidities compared to men (P <.001). Women were also found to have worse bladder cancer-specific survival (CSS) than men (hazard ratio [HR] 1.18; 95% CI 1.05-1.32), no difference in overall survival (OS) (female HR 0.93; 0.86-1.01) and lower mortality from other causes (HR 0.78; 95% CI 0.70-0.86). There were no differences in OS and CSS by sex in patients with stage pT4a. CONCLUSION Female sex predicted more aggressive treatment with radical cystectomy yet worse cancer-specific survival than males. This sex disparity in CSS reduced the known OS advantage observed in women.
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Affiliation(s)
- Valentina Grajales
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Jathin Bandari
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Nathan E Hale
- Department of Urology, Charleston Area Medical Center, Charleston, WV
| | - Jonathan G Yabes
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Robert M Turner
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mina M Fam
- Coastal Urology Associates, Hackensack Meridian Health, Brick, NJ
| | - Lindsay M Sabik
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | | | - Benjamin J Davies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
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Pace NM, Maganty A, Siripong N, Lee AJ, Huang D, Bandari J, Jacobs BL, Davies BJ. Gender Gap in Industry Relationships and Scholarly Impact Among Academic Urologists in the United States. Urology 2020; 139:90-96. [DOI: 10.1016/j.urology.2020.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/09/2020] [Accepted: 01/17/2020] [Indexed: 10/25/2022]
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Shah* A, Ayyash O, Bandari J, Kumar P, Yabes J, Odisho A, Davies B, Jacobs B. MP27-18 STATEWIDE GEOGRAPHIC PRICE VARIATION OF GENERIC BPH MEDICATIONS. J Urol 2020. [DOI: 10.1097/ju.0000000000000866.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bandari J, Pace NM, Lee AJ, Ayyash OM, Yecies TS, Jacobs BL, Davies BJ. Strong Conflict of Interest Policies are not Associated With Decreased Industry Payments to Academic Urology Departments. Urology 2020; 140:51-55. [PMID: 32165276 DOI: 10.1016/j.urology.2020.02.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To identify whether institutions with strong conflicts of interest (COI) policies receive less industry payments than those with weaker policies. While industry-physician interactions can have collaborative benefits, financial COI can undermine preservation of the integrity of professional judgment and public trust. To address this concern, academic institutions have adopted COI policies. It is unclear whether the strength of COI policy correlates with industry payments in urology. MATERIALS AND METHODS 131 US academic urology programs were surveyed on their COI policies, and graded according to the American Medical Student Association (AMSA) criteria. Strength of COI policy was compared against industry payments in the Center for Medicare and Medicaid Services Open Payments database. RESULTS Fifty-seven programs responded to the survey, for a total response rate of 44%. There was no difference between COI policy groups on total hospital payments (P = .05), total department payments (P = .28), or dollars per payment (P = .57). On correlation analysis, there was a weak but statistically nonsignificant correlation between AMSA Industry Policy Survey Score and Open Payments payments (ρ = -0.14, P = .32). CONCLUSION Strength of conflicts of interest policy in academic urology did not correlate to industry payments within the Open Payments database. Establishment of strong COI policy may create offsetting factors that mitigate the intended effects of the policy. Further studies will be required to develop the evidence base for policy design and implementation across various specialties.
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Affiliation(s)
- Jathin Bandari
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Natalie M Pace
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Austin J Lee
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Omar M Ayyash
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Todd S Yecies
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Benjamin J Davies
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Myrga JM, Macleod LC, Bandari J, Jacobs BL, Davies BJ. Decrease in Urologic Discharge Opioid Prescribing after Mandatory Query of Statewide Prescription Drug Monitoring Program. Urology 2020; 139:84-89. [PMID: 32061826 DOI: 10.1016/j.urology.2020.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the effectiveness of the introduction of the Pennsylvania Prescription Drug Monitoring Program (PDMP) on discharge postoperative opioid prescriptions in patients undergoing major urologic procedures within a large single tertiary care hospital. Opioids have historically been prescribed to control postoperative pain, but with growing concern regarding opioid overdose, misuse, and diversion, measures have been introduced to curb opioid prescribing. Numerous states have introduced PDMP programs as a method to search patients' prior opioid prescriptions. These programs have reduced opioid prescriptions in emergency department and outpatient settings, but their effectiveness, and the use of a prescriber query mandate, in reducing postoperative opioid prescribing has not been established. METHODS We identified 582 patients who underwent major prostate or renal surgery between July 1st 2016 and June 30th 2017 at a single large academic hospital. We examined prescribing trends in both opioid naive and opioid tolerant patients measuring 5mg oxycodone equivalents before and after a PDMP query was mandated on January 1st 2017. RESULTS There was no significant difference is the number of opioid prescriptions given after introduction of the required PDMP query, but there was an 18% decrease in the median number of 5mg oxycodone equivalents prescribed before and after the PDMP query (P < .001). This was consistent in both an opioid naive and opioid exposed population. CONCLUSION This is the first study to establish that required PDMP queries may reduce the number of discharge opioid pills prescribed in a surgical setting. Required PDMP queries may help reduce the harm associated with opioid overprescribing.
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Affiliation(s)
- John M Myrga
- University of Pittsburgh School of Medicine, Department of Urology, Pittsburgh, PA.
| | | | - Jathin Bandari
- University of Pittsburgh School of Medicine, Department of Urology, Pittsburgh, PA
| | - Bruce L Jacobs
- University of Pittsburgh School of Medicine, Department of Urology, Pittsburgh, PA
| | - Benjamin J Davies
- University of Pittsburgh School of Medicine, Department of Urology, Pittsburgh, PA
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Yecies T, Bandari J, Macleod L, Fam M, Davies BJ, Jacobs BL. Evaluation of the Risks and Benefits of Computed Tomography Urography for Assessment of Gross Hematuria. Urology 2019; 133:40-45. [DOI: 10.1016/j.urology.2019.04.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/11/2019] [Accepted: 04/27/2019] [Indexed: 01/19/2023]
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Myrga JM, Ayyash OM, Bandari J, Fam MM, Macleod LC, Jacobs BL, Davies BJ. The Safety and Short-term Outcomes of Leukocyte Depleted Autologous Transfusions During Radical Cystectomy. Urology 2019; 135:106-110. [PMID: 31626857 DOI: 10.1016/j.urology.2019.08.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/18/2019] [Accepted: 08/21/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine long- and short-term outcomes using cell salvage with a commercially available leukocyte depletion filter following radical cystectomy in an oncologic population. MATERIALS AND METHODS One hundred and fifty-seven patients, 87 of whom received a cell salvage transfusion, were retrospectively identified from chart review. Ninety-day outcomes as well as long-term mortality and cancer recurrence data were collected. Chi-square, Student's t, or Mann-Whitney U tests were used as appropriate. Multivariable regressions of survival were performed with a Cox proportional-hazards model. RESULTS Those who received a cell salvage transfusion did not show any differences in rate of cancer recurrence (23%) vs those who did not receive a cell salvage transfusion (24%; P = .85). There were also no differences noted in mortality rates between the 2 populations (12% vs 17%; P = .36). Furthermore, no differences were noted in postoperative complication rates, length of hospital stay, 90-day culture positive infections or readmissions (P >.05). CONCLUSION There are no significant differences in short-term or long-term patient outcomes between those who did and did not receive an intraoperative cell salvage transfusion. Cell salvage transfusions with a leukocyte depletion filter are safe and effective methods to reduce the need for allogeneic blood transfusions while controlling for the theoretical risk of metastatic spread.
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Affiliation(s)
- John M Myrga
- University of Pittsburgh School of Medicine, Pittsburgh, PA; University of Pittsburgh School of Medicine, Department of Urology, Pittsburgh, PA.
| | - Omar M Ayyash
- University of Pittsburgh School of Medicine, Department of Urology, Pittsburgh, PA
| | - Jathin Bandari
- University of Pittsburgh School of Medicine, Department of Urology, Pittsburgh, PA
| | - Mina M Fam
- Jersey Shore University Medical Center, Monmouth, NJ
| | | | - Bruce L Jacobs
- University of Pittsburgh School of Medicine, Department of Urology, Pittsburgh, PA
| | - Benjamin J Davies
- University of Pittsburgh School of Medicine, Department of Urology, Pittsburgh, PA
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Macleod LC, Yabes JG, Fam MM, Bandari J, Yu M, Maganty A, Furlan A, Filson CP, Davies BJ, Jacobs BL. Multiparametric Magnetic Resonance Imaging Is Associated with Increased Medicare Spending in Prostate Cancer Active Surveillance. Eur Urol Focus 2019; 6:242-248. [PMID: 31031042 DOI: 10.1016/j.euf.2019.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/22/2019] [Accepted: 04/10/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mpMRI) may improve prostate cancer risk stratification and decrease the need for repeat biopsies in men on prostate cancer active surveillance (AS). However, the impact of mpMRI on AS-related healthcare spending has not been established. OBJECTIVE To characterize the impact of mpMRI on AS-related Medicare expenditures. DESIGN, SETTING, AND PARTICIPANTS Using Surveillance, Epidemiology, and End Results (SEER)-Medicare files, we identified men ≥66 yr old with localized prostate cancer diagnosed during 2008-2013. OUTCOME MEASURES AND STATISTICAL ANALYSIS With a validated algorithm, we classified men into AS with and without mpMRI groups. We then determined Medicare spending on AS in each group using inflation-adjusted, price-standardized Medicare payments for AS-related procedures (ie, prostate-specific antigen [PSA] tests, prostate biopsies, biopsy complications, and mpMRI). Multivariable median regression compared Medicare spending on AS for men who received mpMRI and those who did not. RESULTS AND LIMITATIONS We identified 9081 men on AS with a median follow-up of 45 mo (interquartile range 29-64 mo). Thirteen percent (N = 1225) received mpMRI. On multivariable median regression, receipt of mpMRI was associated with an additional $447 (95% confidence interval $409-487) in Medicare spending per year. We observed greater frequency of AS-related procedures and higher spending for identical procedures (eg, PSA or prostate biopsy) in the mpMRI group than in the non-mpMRI group (all p < 0.001). CONCLUSIONS Among Medicare beneficiaries on AS, mpMRI is associated with additional annual Medicare spending. Future studies are needed to determine optimal use of mpMRI during AS to maximize value. PATIENT SUMMARY Prostate magnetic resonance imaging (MRI) helps physicians determine which prostate cancers are aggressive and which can be monitored safely. We studied whether using MRI during prostate cancer monitoring (also called active surveillance) resulted in increased healthcare spending. There was a modest increase in spending, but this may be worthwhile if the use of MRI allows physicians to monitor prostate cancer more accurately.
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Affiliation(s)
- Liam C Macleod
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Jonathan G Yabes
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mina M Fam
- Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Jathin Bandari
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michelle Yu
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Avinash Maganty
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alessandro Furlan
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Benjamin J Davies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Fam MM, Yabes JG, Macleod LC, Bandari J, Turner RM, Lopa SH, Furlan A, Filson CP, Davies BJ, Jacobs BL. Increasing Utilization of Multiparametric Magnetic Resonance Imaging in Prostate Cancer Active Surveillance. Urology 2019; 130:99-105. [PMID: 30940480 DOI: 10.1016/j.urology.2019.02.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/16/2019] [Accepted: 02/06/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To characterize the use of multiparametric magnetic resonance imaging (mpMRI) in male Medicare beneficiaries electing active surveillance for prostate cancer. mpMRI has emerged as a tool that may improve risk-stratification and decrease repeated biopsies in men electing active surveillance. However, the extent to which mpMRI has been implemented in active surveillance has not been established. METHODS Using Surveillance, Epidemiology, and End Results registry data linked to Medicare claims data, we identified men with localized prostate cancer diagnosed between 2008 and 2013 and managed with active surveillance. We classified men into 2 treatment groups: active surveillance without mpMRI and active surveillance with mpMRI. We then fit a multivariable logistic regression models to examine changing mpMRI utilization over time, and factors associated with the receipt of mpMRI. RESULTS We identified 9467 men on active surveillance. Of these, 8178 (86%) did not receive mpMRI and 1289 (14%) received mpMRI. The likelihood of receiving mpMRI over the entire study period increased by 3.7% (P = .004). On multivariable logistic regression, patients who were younger, white, had lower comorbidity burden, lived in the northeast and west, had higher incomes and lived in more urban areas had greater odds of receiving mpMRI (all P < .05). CONCLUSION From 2008 to 2013, use of mpMRI in active surveillance increased gradually but significantly. Receipt of mpMRI among men on surveillance for prostate cancer varied significantly across demographic, geographic, and socioeconomic strata. Going forward, studies should investigate causes for this variation and define ideal strategies for equitable, cost-effective dissemination of mpMRI technology.
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Affiliation(s)
- Mina M Fam
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jonathan G Yabes
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Liam C Macleod
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Jathin Bandari
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Robert M Turner
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Samia H Lopa
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Alessandro Furlan
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Benjamin J Davies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
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20
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Maganty A, Yu M, Macleod LC, Yabes JG, Fam MM, Bandari J, Turner R, Furlan A, Filson CP, Davies BJ, Jacobs BL. Increasing utilization of multi-parametric magnetic resonance imaging in prostate cancer active surveillance. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
125 Background: Multi-parametric resonance imaging (mpMRI) has emerged as a tool that may improve risk-stratification and decrease repeated biopsies in men electing active surveillance. However, the extent to which mpMRI has been implemented in active surveillance has not been established. Therefore, we sought to characterize the use of multiparametric magnetic resonance imaging (mpMRI) in Medicare beneficiaries electing active surveillance for prostate cancer. Methods: SEER-Medicare claims data, we identified men with localized prostate cancer diagnosed between 2008-2013 and managed with active surveillance. We classified men into two treatment groups: active surveillance without mpMRI and active surveillance with mpMRI. We then fit a multivariable logistic regression models to examine changing mpMRI utilization over time, and factors associated with the receipt of mpMRI. Results: We identified 9,467 men on active surveillance. Of these, 8,178 (86%) did not receive mpMRI and 1,289 (14%) received mpMRI. The likelihood of receiving mpMRI over the entire study period increased by 3.7% (p = 0.004). On multivariable logistic regression, patients who were younger, white, had lower comorbidity burden, lived in the northeast and west, had higher incomes and lived in more urban areas had greater odds of receiving mpMRI (all p < 0.05). Conclusions: From 2008-2013, use of mpMRI in active surveillance increased gradually but significantly. Receipt of mpMRI among men on surveillance for prostate cancer varied significantly across demographic, geographic and socioeconomic strata. Going forward, studies should investigate causes for this variation and define ideal strategies for equitable, cost-effective dissemination of mpMRI technology.
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Affiliation(s)
| | - Michelle Yu
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | - Mina M Fam
- Jersey Shore University Medical Center, Neptune, NJ
| | | | - Robert Turner
- University of Pittsburgh Medical Center, Pittsburgh, PA
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21
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Yu M, Maganty A, Macleod LC, Yabes JG, Fam MM, Bandari J, Furlan A, Turner R, Filson CP, Davies BJ, Jacobs BL. Cost implications of multi-parametric magnetic resonance imaging in prostate cancer active surveillance. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
65 Background: Multi-parametric resonance imaging (mpMRI) has emerged to improve disease risk-stratification and decrease number of repeat biopsies in men on prostate cancer active surveillance (AS). However, the impact of mpMRI on cost of AS has not been established. We thus characterize the impact mpMRI on cost of AS in the Medicare population. Methods: Using SEER-Medicare files we identified men ≥66 years old with localized grade group I-II prostate cancer diagnosed 2008-2013. With an established algorithm, we classified men into active surveillance with and without mpMRI. We then determined cost of surveillance in each group using inflation-adjusted Medicare payments for surveillance-related procedures and their sequalae (i.e. PSA tests, prostate biopsies, post-biopsy complications and mpMRIs). Multivariable median regression compared cost and procedural-intensity for men who received mpMRI and those who did not. Results: We identified 9,081 men on AS with median follow up 45 months (IQR 29-64 months). 7,856 (87%) men did not receive mpMRI and 1,225 (13%) did. On multivariable median regression, receipt of mpMRI was associated with an additional $449 (95%CI $391-$507) in Medicare payments per year. Younger age, treatment in the west or northeast, greater population density and treatment later in the study period were associated with increased cost of AS. Conclusions: Among Medicare beneficiaries on AS, mpMRI is associated with additional annual cost to Medicare. MpMRI may be a marker of more stringent AS, which is likely more costly than watchful waiting. Future studies are needed to determine optimal use of mpMRI during AS to maximize value.
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Affiliation(s)
- Michelle Yu
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | | | - Mina M Fam
- Jersey Shore University Medical Center, Neptune, NJ
| | | | | | - Robert Turner
- University of Pittsburgh Medical Center, Pittsburgh, PA
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Bandari J, Maganty A, Davies BJ. Editorial Comment. Urology 2019; 124:125-126. [DOI: 10.1016/j.urology.2018.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- Austin J Lee
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Jathin Bandari
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Liam C Macleod
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Benjamin J Davies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Bandari J, Nielsen ME, Jacobs BL, Smith KJ. Cost-Effectiveness of Single Versus Confirmatory Urinalysis in the Evaluation of Asymptomatic Microhematuria. Urology Practice 2018. [DOI: 10.1016/j.urpr.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jathin Bandari
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthew E. Nielsen
- Department of Urology, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Bruce L. Jacobs
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kenneth J. Smith
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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25
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Theisen KM, Park SY, Jeong K, Macleod LC, Bandari J, Ayyash O, Odisho AY, Jacobs BL, Davies BJ. Extreme Price Variation for Generic Benign Prostatic Hyperplasia Medications. Urology 2018; 124:223-228. [PMID: 30359708 DOI: 10.1016/j.urology.2018.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/27/2018] [Accepted: 10/04/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To characterize geographic variability of generic benign prostatic hyperplasia (BPH) medications in order to improve drug price transparency and improve patient access to affordable medication sources. This is of interest because BPH is one of the most common chronic diseases in men and contributes to individual healthcare cost. Medical therapy is the main treatment modality for BPH, burdening patients with lifelong medication expenses which may impact adherence and subsequent outcomes. With an aging population, this is compounded by many older individuals requiring multiple daily medications. METHODS All pharmacies within a 25-mile radius of our institution were identified and classified as chain, wholesale or independent. The out-of-pocket price for a 30-day supply of tamsulosin (0.4 mg), finasteride (5 mg), oxybutynin (5 mg TID), and oxybutynin 10 mg XL were obtained using a scripted telephone survey. Multivariable linear regression assessed the association between census-tract level demographic and socioeconomic factors and disparate generic out-of-pocket drug-pricing. RESULTS The response rate was 93% with 255 pharmacies across 173 census tracts providing data. By pharmacy type, there was up to 5.5-fold variation in median out-of-pocket drug prices for the most common BPH medications. Demographic and socioeconomic factors were not significantly associated with generic BPH drug price variation. CONCLUSION The out-of-pocket price of generic medications for BPH varies significantly between pharmacies in a geographically-confined area. This study highlights the need for quality improvement initiatives that empower patients to price-compare and improve drug price transparency.
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Affiliation(s)
| | - Seo Young Park
- University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Kwonho Jeong
- University of Pittsburgh School of Medicine, Pittsburgh PA
| | | | | | - Omar Ayyash
- University of Pittsburgh Medical Center, Pittsburgh PA
| | - Anobel Y Odisho
- University of San Francisco School of Medicine, San Francisco, CA
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Jimbo M, Granberg CF, Osumah TS, Bandari J, Cannon GM, Routh JC, Gargollo PC. Discrepancies in Self-Reported and Actual Conflicts of Interest for Robotic Pediatric Urological Surgery. J Urol 2018; 201:393-399. [PMID: 30053509 DOI: 10.1016/j.juro.2018.07.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE Transparency of conflicts of interest is essential when assessing publications that address the benefits of robotic surgery over traditional laparoscopic and open operations. We assessed discrepancies between self-reported and actual conflicts of interest as well as whether conflicts of interest are associated with favorable endorsement of robotic surgery. MATERIALS AND METHODS We searched the Embase® and MEDLINE® databases for articles on robotic surgery within pediatric urology. We included English language articles published since 2013, when data in the Open Payments program (Centers for Medicare and Medicaid Services, Baltimore, Maryland) became available. For all United States based authors Open Payments was used to identify the total amount of financial payment received from Intuitive Surgical®. Chi-square test was used to assess the association between conflicts of interest and favorable endorsement of robotic surgery. RESULTS A total of 191 articles were initially identified. After exclusion criteria were applied 107 articles remained (267 distinct authors). Of the articles 86 (80.4%) had at least 1 author with a history of payment from Intuitive Surgical, with 79 (91.9%) having at least 1 author who did not declare a conflict of interest despite history of payment. A total of 44 authors (16.5%) had a history of payment from Intuitive Surgical, with an average payment of $3,594.15. Articles with a first and/or last author with a history of payment were more likely to contain a favorable endorsement of robotic surgery compared to articles without a history of payment (85.1% vs 63.6%, p = 0.0124). CONCLUSIONS Nondisclosure of conflict of interest with Intuitive Surgical is extremely common within pediatric urology. Steps to ensure accurate reporting of conflicts of interest are essential. There appears to be an association between a history of payment and favorable endorsement of robotic surgery.
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Affiliation(s)
- Masaya Jimbo
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Jathin Bandari
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Glenn M Cannon
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jonathan C Routh
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina
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Bandari J, Maganty A, MacLeod LC, Davies BJ. Manufacturing and the Market: Rationalizing the Shortage of Bacillus Calmette-Guérin. Eur Urol Focus 2018; 4:481-484. [DOI: 10.1016/j.euf.2018.06.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 06/15/2018] [Accepted: 06/28/2018] [Indexed: 11/28/2022]
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28
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Yecies T, Bandari J, Fam M, Macleod L, Jacobs B, Davies B. Risk of Radiation from Computerized Tomography Urography in the Evaluation of Asymptomatic Microscopic Hematuria. J Urol 2018; 200:967-972. [PMID: 29857078 DOI: 10.1016/j.juro.2018.05.118] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE The AUA (American Urological Association) guidelines for asymptomatic microscopic hematuria recommend that patients undergo computerized tomography urography, which is associated with high doses of ionizing radiation. To our knowledge the associated risk of secondary malignancy and mortality remains unknown. We modeled the risk of malignancy and associated mortality due to ionizing radiation from computerized tomography urography relative to the additional diagnostic benefit offered over renal ultrasound. MATERIALS AND METHODS We performed a PubMed® based literature search to identify model inputs. We obtained estimates of age and gender specific radiation induced secondary malignancy and mortality rates from the BEIR (Biologic Effects of Ionizing Radiation) VII Phase 2 report with dose extrapolation using the linear no threshold model. RESULTS Patients with asymptomatic microscopic hematuria had a 0.053% and 0.48% prevalence of upper tract urothelial carcinoma and renal cell carcinoma, respectively. Ultrasound had 77% sensitivity for upper tract urothelial carcinoma and 82% sensitivity for renal cell carcinoma. The effective radiation dose of computerized tomography urography was 31.7 mSv. Based on these inputs a population of 100,000 patients with asymptomatic microscopic hematuria would include 53.1 and 478 patients with upper tract urothelial carcinoma and renal cell carcinoma, respectively. On ultrasound alone 98.2 cases of upper urinary tract malignancy would be missed. An additional 149 cases of secondary malignancy would be caused by computerized tomography urography associated radiation with 101 fatalities. A total of 1,018.3 computerized tomography urography studies would need to be performed to detect an additional case of upper tract malignancy. CONCLUSIONS Based on current risk models computerized tomography urography for asymptomatic microscopic hematuria may be associated with a small but significant risk of secondary malignancy relative to the additional diagnostic benefit offered.
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Affiliation(s)
- Todd Yecies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Jathin Bandari
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mina Fam
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Liam Macleod
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Bruce Jacobs
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Benjamin Davies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Fam M, Yabes J, Hale N, Turner R, Bandari J, Macleod L, Hugar L, Gingrich J, Borza T, Skolarus T, Davies B, Jacobs B. MP71-20 COMPARATIVE EFFECTIVENESS OF NEOADJUVANT AND ADJUVANT CHEMOTHERAPY IN THE MEDICARE BLADDER CANCER POPULATION. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bandari J, Ayyash O, Emery S, Wessel C, Davies B. MP44-09 MARKETING AND TESTOSTERONE TREATMENT IN THE UNITED STATES. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Maganty A, Correa A, Bandari J, Hrebinko R, Davies B, Maranchie J, Jackman S. MP48-08 ONCOLOGIC OUTCOMES OF SIMPLE ENUCLEATION PARTIAL NEPHRECTOMY IN SPORADIC TYPE 2 PAPILLARY RENAL CELL CARCINOMA. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Yecies T, Bandari J, Jacobs B, Davies B. MP02-03 EVALUATION OF THE RISKS AND BENEFITS OF CT UROGRAPHY FOR ASSESSMENT OF GROSS HEMATURIA. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bandari J, Raju G, Docimo S. MP69-01 COST ANALYSIS OF THE MANAGEMENT OF PEDIATRIC FEBRILE UTI: TRADITIONAL, AAP, AND POPULATION HEALTH ALGORITHMS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yecies T, Bandari J, Davies B, Jacobs B. MP80-17 MODELING THE RISK OF RADIATION FROM CT UROGRAPHY IN THE EVALUATION OF ASYMPTOMATIC MICROSCOPIC HEMATURIA. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Morgan TN, Bandari J, Hale N, Davies B. Inguinal Herniation of Perinephric Tissue: Case Report and Review of the Literature. J Osteopath Med 2017; 117:786-788. [DOI: 10.7556/jaoa.2017.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Inguinal hernias containing a kidney or perinephric tissue are extremely rare and usually related to cases involving a kidney positioned in the pelvis. We report the case of a 79-year-old man who presented with abdominal pain and scrotal swelling. He was found on imaging to have an inferiorly displaced kidney with an inguinal herniation of Gerota fascia, as well as an obstructing ureteral stone with an associated forniceal rupture. The unusual renal anatomy, as well as the management of a forniceal rupture, is discussed.
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Bandari J, Ayyash OM, Emery SL, Wessel CB, Davies BJ. Marketing and Testosterone Treatment in the USA: A Systematic Review. Eur Urol Focus 2017; 3:395-402. [PMID: 29174614 DOI: 10.1016/j.euf.2017.10.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 10/21/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
Abstract
CONTEXT Testosterone replacement therapy (TRT) is currently approved by the Food and Drug Administration only for classic hypogonadism, although off-label indications have resulted in a dramatic expansion in prescriptions in the USA. Marketing may significantly affect prescriber behavior. OBJECTIVE To systematically review all available evidence on marketing and TRT in the USA. EVIDENCE ACQUISITION PubMed, Embase, and Scopus were searched up to July 2017 for all relevant publications reporting on assessments of the TRT market size, economic costs associated with hypogonadism, trends in TRT prescriptions, drug discontinuation rates, and advertising and sales efforts in the USA. EVIDENCE SYNTHESIS Twenty retrospective studies were included in the final analysis. The market size for hypogonadism constitutes 5.6-76.8% of men in the USA, with the lower end of the range representing the strictest criteria for diagnosis. Men with a diagnosis of hypogonadism consume $14 118 in direct and indirect costs to the payer. Over the last 2 decades, TRT prescriptions have increased between 1.8- and 4-fold. After 1 yr, 80-85% of men discontinue TRT. There is an association between direct-to-consumer advertising and testosterone testing, TRT prescriptions, and TRT without testosterone testing. There is a high prevalence of misinformation on Internet advertising. CONCLUSIONS Off-label indications have driven the dramatic expansion of TRT prescriptions over the last 2 decades. Direct-to-consumer advertising poses a unique challenge in the USA. Overtreatment can be avoided by applying strict diagnostic criteria for hypogonadism, which limits the addressable market for TRT. PATIENT SUMMARY In this report, we reviewed the relationship between marketing and testosterone therapy in the USA. We found that many patients are prescribed testosterone without an appropriate diagnosis of hypogonadism, which may be related to the marketing efforts for off-label prescribing.
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Affiliation(s)
- Jathin Bandari
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Omar M Ayyash
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Charles B Wessel
- University of Pittsburgh Health Sciences Library System, Pittsburgh, PA, USA
| | - Benjamin J Davies
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Morgan TN, Bandari J, Shahait M, Averch T. Renal Forniceal Rupture: Is Conservative Management Safe? Urology 2017; 109:51-54. [PMID: 28801219 DOI: 10.1016/j.urology.2017.07.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/24/2017] [Accepted: 07/31/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To outline treatment considerations and outcomes for a cohort of patients with forniceal rupture with the aim of adding to a very limited body of literature regarding clinical practice in this area. METHODS We retrospectively searched all radiographic records for patients treated at our institution between January 2009 and January 2016 with forniceal rupture. We compiled demographic data, etiology, clinical factors, treatments, and outcomes. RESULTS Of the 103 patients analyzed, the median age at presentation was 64 years (interquartile range 52-73), and 56 (54%) were female. The etiology of forniceal rupture was most commonly urolithiasis (73%), with cancer being the next most common cause (11%). Most cases (61%) were caused by small (1-5 mm) stones in the distal ureter. Thirty-one patients (30%) were treated surgically with ureteral stent placement upfront; 27 of those patients had a ureteral stone, and most had some clinical factors making them higher risk. There was only 1 operative complication during the study period. Only 1 patient developed an abscess. Forty-three patients (42%) were sent home from the emergency room. Of the patients who were admitted, the average hospital stay was 3 days (interquartile range 2-6). For the entire cohort, there were 6 (6%) readmissions in the study period. CONCLUSION Very limited data exist in the literature regarding clinical practice in the treatment of forniceal rupture. Clinical practice at our institution is conservative treatment of forniceal rupture in the absence of infection, kidney failure, or other risk factors with few complications or readmissions.
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Affiliation(s)
- Tara Nikonow Morgan
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Jathin Bandari
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mohammed Shahait
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Timothy Averch
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Abstract
We performed a review of the recent literature concerning urinary tract infection (UTI) evaluation and management. In modeling options for management, one overriding conclusion became apparent: in most affected children, the presence of vesicoureteral reflux (VUR) is inconsequential since it has no bearing on optimal management or outcome. In fact, knowing that a child does not have reflux might bias the provider to withhold potentially helpful therapeutic modalities to decrease UTI morbidity, such as antibiotic prophylaxis. In this review, we will propose that evaluation for VUR is not necessary or helpful except in the small subset of children whose UTIs have proven refractory to management of their other risk factors.
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Affiliation(s)
- Jathin Bandari
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Steven G Docimo
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Bandari J, Ayyash OM, Turner RM, Jacobs BL, Davies BJ. The lack of a relationship between physician payments from drug manufacturers and Medicare claims for abiraterone and enzalutamide. Cancer 2017; 123:4356-4362. [PMID: 28749536 DOI: 10.1002/cncr.30914] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/10/2017] [Accepted: 06/12/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Interactions between industry and prescribers have raised concerns regarding conflicts of interest. To the best of the authors' knowledge, quantitative data measuring these interactions have been limited until recently. In the current study, the authors sought to determine whether an association exists between industry payments and prescriber behavior with regard to abiraterone and enzalutamide. METHODS Two Centers for Medicare and Medicaid Services databases were combined to analyze oncologists and urologists who received industry payments and/or prescribed abiraterone and enzalutamide. Correlation analysis was constructed on prescription count and industry payments. Multivariable median regression examined predictors of change in prescription count per dollar of industry payment. Stratifying prescribers by quantile evaluated threshold effects on prescribers. RESULTS The number of prescriptions was similar between prescribers who did and those who did not receive industry payment for both drugs. The median industry payment amount to prescribers differed between prescribers and nonprescribers for abiraterone ($72 vs $56) and enzalutamide ($59 vs $31). Although no statistical association was found to exist between industry payment amount and prescription count for abiraterone prescribers, an association was found to exist for enzalutamide prescribers (rho = 0.31). A small change was found with regard to prescription count per dollar of industry payment for abiraterone (0.0007 prescriptions) and enzalutamide (0.0006 prescriptions). The amount of industry payment needed to predict one additional prescription was found to be lower in the fourth and fifth quantiles compared with the first through third quantiles. CONCLUSIONS No difference in prescription count was found to exist between prescribers who received industry payments and those who did not. A positive correlation was noted between industry payments and prescription count for enzalutamide. Ease of adoption may affect differences between the 2 drugs. Cancer 2017;123:4356-62. © 2017 American Cancer Society.
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Affiliation(s)
- Jathin Bandari
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Omar M Ayyash
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert M Turner
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Benjamin J Davies
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Bandari J, Jacobs BL. Editorial Commentary. Urology Practice 2017; 4:347. [PMID: 28775999 PMCID: PMC5538307 DOI: 10.1016/j.urpr.2016.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jathin Bandari
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Bruce L. Jacobs
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Abstract
Under the Sunshine Act, pharmaceutical and product industry payments to physicians are reported in a public database. We sought to characterize payments received by pediatricians in the first full year of disclosures in 2014. We used the National Centers for Medicare and Medicaid Services Open Payment files to identify pediatricians who received payments. Payment characteristics were stratified, and descriptive statistical analysis was performed, including mean, median, and ranges of payments. Between January 1, 2014, and December 31, 2014, 35 697 pediatricians received payments amounting to $30 031 960. General pediatricians received the majority of payments (71%). Median payment was $15 (interquartile range = $12-$24), mostly in the form of noncash items and services (84%). Significant diversity was observed in median payments among specialty providers. In conclusion, 42% of US pediatricians received industry payments in 2014. These data provide a foundation for future research regarding the influence of the Sunshine Act on pediatric clinical practices.
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Affiliation(s)
| | - Jathin Bandari
- 2 University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Bruce L Jacobs
- 2 University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Ayyash O, Bandari J, Turner R, Jacobs B, Davies B. MP76-03 SMALL EFFECT OF PHARMACEUTICAL INDUSTRY PAYMENTS TO PHYSICIANS ON MEDICARE PRESCRIPTION HABITS: USING ABIRATERONE AND ENZALUTAMIDE. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bandari J, Turner RM, Jacobs BL, Canes D, Moinzadeh A, Davies BJ. The Relationship of Industry Payments to Prescribing Behavior: A Study of Degarelix and Denosumab. Urol Pract 2017; 4:14-20. [PMID: 28149927 DOI: 10.1016/j.urpr.2016.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The influence of financial ties to pharmaceutical companies remains controversial. We aimed to assess a potential relationship between pharmaceutical payments and prescription patterns for degarelix and denosumab. MATERIALS AND METHODS Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (Medicare B) data containing 2012 claims compared to OpenPayments (Sunshine Act) data for the second half of 2013. Urologists and medical oncologists who billed Medicare for degarelix or denosumab were cross referenced in both databases and payments were aggregated into a consolidated dataset. Adjusted beneficiary count and total Medicare reimbursement were compared according to receipt of Sunshine payment, and an association between Sunshine payment amount and total Medicare reimbursement was also assessed. RESULTS Of the 160 prescribers of degarelix and 1,507 prescribers of denosumab, 91 (57%) and 854 (57%) received Sunshine payment, respectively. Degarelix prescribers who received Sunshine payment had higher median total Medicare reimbursement ($13,257 vs. $9,554, p = 0.01). Denosumab prescribers who received Sunshine payment had both higher median adjusted beneficiary count (55 vs. 50, p < 0.001) and median total Medicare reimbursement ($69,620 vs. $60,732, p < 0.001). On multivariable analysis, both receipt of Sunshine payment (adjusted median difference $5,844, 95% CI $937 - $10,749) and oncology specialty (adjusted median difference $34,380, 95% CI $26,715 - $42,045) were independently associated with total Medicare reimbursement for denosumab. CONCLUSIONS In the case of degarelix and denosumab, there is a weak association between pharmaceutical company payments on prescribers' prescription behavior patterns.
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Affiliation(s)
- Jathin Bandari
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA 15213
| | - Robert M Turner
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA 15213
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA 15213
| | - David Canes
- Lahey Institute of Urology, Lahey Hospital and Medical Center, Burlington, MA, USA 01805
| | - Ali Moinzadeh
- Lahey Institute of Urology, Lahey Hospital and Medical Center, Burlington, MA, USA 01805
| | - Benjamin J Davies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA 15213
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Bansal U, Fuller TW, Jiang X, Bandari J, Zhang Z, Shen B, Wang J, Roppolo JR, de Groat WC, Tai C. Lumbosacral spinal segmental contributions to tibial and pudendal neuromodulation of bladder overactivity in cats. Neurourol Urodyn 2016; 36:1496-1502. [PMID: 27778372 DOI: 10.1002/nau.23159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 09/26/2016] [Indexed: 11/06/2022]
Abstract
AIMS To determine the spinal segmental afferent contributions to tibial and pudendal inhibition of bladder overactivity. METHODS Intravesical infusion of 0.5% acetic acid was used to irritate the bladder and induce bladder overactivity in anesthetized cats. Tibial or pudendal nerve stimulation was used to suppress the bladder overactivity and increase bladder capacity during cystometry. L5-S3 dorsal roots ipsilateral to the stimulation were exposed by a laminectomy and transected sequentially during the experiments to determine the role of individual dorsal roots in tibial or pudendal neuromodulation. RESULTS Transection of L5 dorsal root had no effect. Transection of L6 dorsal root in four cats produced an average 18% reduction in tibial inhibition, which is not a significant change when averaged in the group of 10 cats. Transection of L7 dorsal root completely removed the tibial inhibition without changing reflex bladder activity or pudendal inhibition. Transection of S1 dorsal root reduced the pudendal inhibition, after which transection of S2 dorsal root completely removed the pudendal inhibition. Transection of S3 dorsal root had no effect. The control bladder capacity was increased only by transection of S2 dorsal root. CONCLUSIONS This study in cats revealed that tibial and pudendal neuromodulation of reflex bladder overactivity depends on activation of primary afferent pathways that project into different spinal segments. This difference may be related to the recent observation in cats that the two types of neuromodulation have different mechanisms of action.
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Affiliation(s)
- Utsav Bansal
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Thomas W Fuller
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Xuewen Jiang
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China
| | - Jathin Bandari
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Zhaocun Zhang
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China
| | - Bing Shen
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jicheng Wang
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James R Roppolo
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Changfeng Tai
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Bandari J, Bansal U, Zhang Z, Shen B, Wang J, Lamm V, Chang V, Roppolo JR, de Groat WC, Tai C. Neurotransmitter Mechanisms Underlying Sacral Neuromodulation of Bladder Overactivity in Cats. Neuromodulation 2016; 20:81-87. [PMID: 27730701 DOI: 10.1111/ner.12534] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/02/2016] [Accepted: 09/10/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the role of opioid, β-adrenergic, and metabotropic glutamate 5 receptors in sacral neuromodulation of bladder overactivity. MATERIAL AND METHODS In α-chloralose anesthetized cats, intravesical infusion of 0.5% acetic acid (AA) irritated the bladder and induced bladder overactivity. Electric stimulation (5 Hz, 0.2 ms, 0.16-0.7V) of S1 or S2 sacral dorsal roots inhibited the bladder overactivity. Naloxone, propranolol, or MTEP were given intravenously (i.v.) to determine different neurotransmitter mechanisms. RESULTS AA significantly (p < 0.05) reduced bladder capacity to 7.7 ± 3.3 mL from 12.0 ± 5.0 mL measured during saline infusion. S1 or S2 stimulation at motor threshold intensity significantly (p < 0.05) increased bladder capacity to 179.4 ± 20.0% or 219.1 ± 23.0% of AA control, respectively. Naloxone (1 mg/kg) significantly (p < 0.001) reduced the control capacity to 38.3 ± 7.3% and the bladder capacity measured during S1 stimulation to 106.2 ± 20.8% of AA control, but did not significantly change the bladder capacity measured during S2 stimulation. Propranolol (3 mg/kg) significantly (p < 0.01) reduced bladder capacity from 251.8 ± 32.2% to 210.9 ± 33.3% during S2 stimulation, but had no effect during S1 stimulation. A similar propranolol effect also was observed in naloxone-pretreated cats. In propranolol-pretreated cats during S1 or S2 stimulation, MTEP (3 mg/kg) significantly (p < 0.05) reduced bladder capacity and naloxone (1 mg/kg) following MTEP treatment further reduced bladder capacity. However, a significant inhibition could still be induced by S1 or S2 stimulation after all three drugs were administered. CONCLUSIONS Neurotransmitter mechanisms in addition to those activating opioid, β-adrenergic, and metabotropic glutamate 5 receptors also are involved in sacral neuromodulation.
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Affiliation(s)
- Jathin Bandari
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Utsav Bansal
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zhaocun Zhang
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Urology, Qilu Hospital, Shandong University, Jinan, China
| | - Bing Shen
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jicheng Wang
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vladimir Lamm
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Victor Chang
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - James R Roppolo
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Changfeng Tai
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
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Jiang X, Fuller TW, Bandari J, Bansal U, Zhang Z, Shen B, Wang J, Roppolo JR, de Groat WC, Tai C. Contribution of GABAA, Glycine, and Opioid Receptors to Sacral Neuromodulation of Bladder Overactivity in Cats. J Pharmacol Exp Ther 2016; 359:436-441. [PMID: 27729478 DOI: 10.1124/jpet.116.235846] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 10/07/2016] [Indexed: 11/22/2022] Open
Abstract
In α-chloralose-anesthetized cats, we examined the role of GABAA, glycine, and opioid receptors in sacral neuromodulation-induced inhibition of bladder overactivity elicited by intravesical infusion of 0.5% acetic acid (AA). AA irritation significantly (P < 0.01) reduced bladder capacity to 59.5 ± 4.8% of saline control. S1 or S2 dorsal root stimulation at threshold intensity for inducing reflex twitching of the anal sphincter or toe significantly (P < 0.01) increased bladder capacity to 105.3 ± 9.0% and 134.8 ± 8.9% of saline control, respectively. Picrotoxin, a GABAA receptor antagonist administered i.v., blocked S1 inhibition at 0.3 mg/kg and blocked S2 inhibition at 1.0 mg/kg. Picrotoxin (0.4 mg, i.t.) did not alter the inhibition induced during S1 or S2 stimulation, but unmasked a significant (P < 0.05) poststimulation inhibition that persisted after termination of stimulation. Naloxone, an opioid receptor antagonist (0.3 mg, i.t.), significantly (P < 0.05) reduced prestimulation bladder capacity and removed the poststimulation inhibition. Strychnine, a glycine receptor antagonist (0.03-0.3 mg/kg, i.v.), significantly (P < 0.05) increased prestimulation bladder capacity but did not reduce sacral S1 or S2 inhibition. After strychnine (0.3 mg/kg, i.v.), picrotoxin (0.3 mg/kg, i.v.) further (P < 0.05) increased prestimulation bladder capacity and completely blocked both S1 and S2 inhibition. These results indicate that supraspinal GABAA receptors play an important role in sacral neuromodulation of bladder overactivity, whereas glycine receptors only play a minor role to facilitate the GABAA inhibitory mechanism. The poststimulation inhibition unmasked by blocking spinal GABAA receptors was mediated by an opioid mechanism.
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Affiliation(s)
- Xuewen Jiang
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J., Z.Z.); Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania (X.J., T.W.F., J.B., U.B., Z.Z., B.S., J.W., C.T.); and Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania (J.R.R., W.C.d.G., C.T.)
| | - Thomas W Fuller
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J., Z.Z.); Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania (X.J., T.W.F., J.B., U.B., Z.Z., B.S., J.W., C.T.); and Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania (J.R.R., W.C.d.G., C.T.)
| | - Jathin Bandari
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J., Z.Z.); Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania (X.J., T.W.F., J.B., U.B., Z.Z., B.S., J.W., C.T.); and Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania (J.R.R., W.C.d.G., C.T.)
| | - Utsav Bansal
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J., Z.Z.); Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania (X.J., T.W.F., J.B., U.B., Z.Z., B.S., J.W., C.T.); and Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania (J.R.R., W.C.d.G., C.T.)
| | - Zhaocun Zhang
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J., Z.Z.); Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania (X.J., T.W.F., J.B., U.B., Z.Z., B.S., J.W., C.T.); and Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania (J.R.R., W.C.d.G., C.T.)
| | - Bing Shen
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J., Z.Z.); Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania (X.J., T.W.F., J.B., U.B., Z.Z., B.S., J.W., C.T.); and Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania (J.R.R., W.C.d.G., C.T.)
| | - Jicheng Wang
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J., Z.Z.); Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania (X.J., T.W.F., J.B., U.B., Z.Z., B.S., J.W., C.T.); and Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania (J.R.R., W.C.d.G., C.T.)
| | - James R Roppolo
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J., Z.Z.); Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania (X.J., T.W.F., J.B., U.B., Z.Z., B.S., J.W., C.T.); and Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania (J.R.R., W.C.d.G., C.T.)
| | - William C de Groat
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J., Z.Z.); Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania (X.J., T.W.F., J.B., U.B., Z.Z., B.S., J.W., C.T.); and Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania (J.R.R., W.C.d.G., C.T.)
| | - Changfeng Tai
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J., Z.Z.); Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania (X.J., T.W.F., J.B., U.B., Z.Z., B.S., J.W., C.T.); and Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania (J.R.R., W.C.d.G., C.T.)
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Abstract
INTRODUCTION Payments to practitioners from drug and device manufacturers or group purchasing organizations are reported in the Centers for Medicare and Medicaid Services (CMS) databases as a part of the Sunshine Act. Characterizing these payments is a necessary step to identifying conflicts of interest and the influence of payments on practice patterns, if any. Payments have never been analyzed in detail amongst Urologists. MATERIALS AND METHODS We reviewed the most recent CMS Open Payments database for the full year 2014, released on June 30, 2015. Urology practitioners were extracted and the database was analyzed for number of total payments, total dollar value of payments, mean, median, number of physicians, number of manufacturers, and number of drugs/biologicals. Data were further categorized according to provider specialty, form of payment, nature of payment, practitioner ownership, and dispute status. RESULTS Payments totaled $32,450,382. Practitioner payments were unevenly distributed, with a median payment of $15. The majority of payments were in the form of food and beverage. Female pelvic medicine practitioners received the highest payments out of the provider specialties. The largest categorical difference from the median was in the form of stock, options, and other ownership interests ($24,050). Ownership status and disputed payments were associated with payment values above median values ($400 and $61, respectively). CONCLUSIONS There are major disparities in industry payments to urology practitioners. Whether or not this influences practice patterns remains to be seen, though identifying categorical differences in payments is an important first step in the process.
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Affiliation(s)
- Jathin Bandari
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA 15213
| | - Robert M Turner
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA 15213
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA 15213
| | - Benjamin J Davies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA 15213
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Zhang Z, Bandari J, Bansal U, Shen B, Wang J, Lamm V, Roppolo JR, de Groat WC, Tai C. Sacral neuromodulation of nociceptive bladder overactivity in cats. Neurourol Urodyn 2016; 36:1270-1277. [PMID: 27571328 DOI: 10.1002/nau.23105] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/05/2016] [Indexed: 01/23/2023]
Abstract
AIMS To investigate the effects of electrical stimulation of sacral dorsal/ventral roots on irritation-induced bladder overactivity, reveal possible different mechanisms under nociceptive bladder conditions, and establish a large animal model of sacral neuromodulation. METHODS Intravesical infusion of 0.5% acetic acid (AA) was used to irritate the bladder and induce bladder overactivity in cats under α-chloralose anesthesia. Electrical stimulation (5, 15, or 30 Hz) was applied to individual S1-S3 dorsal or ventral roots at or below motor threshold intensity. Repeated cystometrograms (CMGs) were performed with/without the stimulation to determine the inhibition of bladder overactivity. RESULTS AA irritation induced bladder overactivity and significantly (P < 0.05) reduced the bladder capacity to 62.6 ± 11.7% of control capacity measured during saline CMGs. At threshold intensity for inducing reflex twitching of the anal sphincter or toe, S1/S2 dorsal root stimulation at 5 Hz but not at 15 or 30 Hz inhibited bladder overactivity and significantly (P < 0.05) increased bladder capacity to 187.3 ± 41.6% and 155.5 ± 9.7% respectively, of AA control capacity. Stimulation of S3 dorsal root or S1-S3 ventral roots was not effective. Repeated stimulation of S1-S3 dorsal root did not induced a post-stimulation inhibition. CONCLUSIONS This study established a cat model of sacral neuromodualation of nociceptive bladder overactivity. The results revealed that the mechanisms underlying sacral neuromodulation are different for nociceptive and non-nociceptive bladder activity.
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Affiliation(s)
- Zhaocun Zhang
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China
| | - Jathin Bandari
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Utsav Bansal
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bing Shen
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jicheng Wang
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vladimir Lamm
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James R Roppolo
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Changfeng Tai
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Bandari J, Dangle PP, Lyon TD, Lee A, Schneck FX, Cannon GM, Stephany HA, Ost MC. 24-Hour Urinary Parameters in Overweight and Obese Children with Urolithiasis. J Urol 2016; 196:526-30. [DOI: 10.1016/j.juro.2016.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Jathin Bandari
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pankaj P. Dangle
- Division of Urology, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Timothy D. Lyon
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andy Lee
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Francis X. Schneck
- Division of Urology, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Glenn M. Cannon
- Division of Urology, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Heidi A. Stephany
- Division of Urology, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael C. Ost
- Division of Urology, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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50
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Zhang Z, Bandari J, Kang A, Lamm V, Wang J, Shen B, Roppolo J, de Groat W, Tai C. MP60-07 SACRAL NEUROMODULATION OF BLADDER OVERACTIVITY IN CATS. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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