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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_3196"
                     title="ESC: Bone Marrow Cells May Help Heal Hearts (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/MeetingCoverage/ESCCongress/tb/21935?impressionId=1283457937716"
                     
      &lt;p&gt;STOCKHOLM  --  Injecting autologous bone marrow stem cells directly into the hearts of patients with chronic heart failure appears to improve ventricular performance, quality of life, and survival, according to an open-label, nonrandomized study.&lt;/p&gt;
&lt;p&gt;Benefits of the stem cell treatment were apparent within three months  --  and persisted for up to five years of follow-up, Bodo-Eckehard Strauer, of Heinrich Heine University of D&amp;#252;sseldorf, Germany, reported at the European Society of Cardiology Congress here.&lt;/p&gt;
&lt;p&gt;Patients who did not receive a stem cell infusion and remained on optimal medical therapy continued to deteriorate throughout the follow-up period.&lt;/p&gt;
&lt;p&gt;There were no side effects, Strauer said in a &quot;Hot Line&quot; session.&lt;/p&gt;
&lt;p&gt;The findings were reported earlier this year in the &lt;em&gt;European Journal of Heart Failure&lt;/em&gt;  --  a journal of the ESC  --  which led the society to bar Strauer from submitting abstracts for two years. Presenting previously-published data broke the rules for &quot;Hot Line&quot; data.&lt;/p&gt;
&lt;p&gt;Strauer said at a press briefing that patients with more severe heart failure seem to fare better from the stem cell treatment.&lt;/p&gt;
&lt;p&gt;&quot;This therapy has almost no risk. It can only be beneficial in patients. So, in my opinion, it has real clinical importance for the treatment of heart failure,&quot; he said.&lt;/p&gt;
&lt;p&gt;Rob Califf, MD, vice chancellor for research at Duke University, highlighted the limitations of the study in his comments to &lt;em&gt;MedPage Today&lt;/em&gt;:&lt;/p&gt;
&lt;p&gt;&quot;God gave us two gifts for doing clinical research  --  blinding and randomization,&quot; Califf said in an interview. &quot;If you have done neither, your data are interesting but not definitive.&quot;&lt;/p&gt;
&lt;p&gt;Strauer and his colleagues initially approached 391 patients with chronic heart failure resulting from an acute MI to participate in the study  --  191 agreed to receive an autologous bone marrow stem cell infusion, and 200 declined but agreed to participate as controls. The average period since patients experienced an MI was 8.5 years.&lt;/p&gt;
&lt;p&gt;Although not randomized, the two groups had similar characteristics at baseline.&lt;/p&gt;
&lt;p&gt;Mean left ventricular ejection fraction was 29.5% in the treatment group and 36.1% in the control group, but the difference was not statistically significant.&lt;/p&gt;
&lt;p&gt;All patients continued to receive optimal medical therapy.&lt;/p&gt;
&lt;p&gt;For the bone marrow cell infusion, the researchers harvested stem cells from the patients&apos; iliac crest. Mononuclear cells were isolated and rinsed with heparinized saline.&lt;/p&gt;
&lt;p&gt;An average of 66 million stem cells per patient were infused into the infarct-related artery via an angioplasty balloon catheter. Inflation of the balloon simulated an ischemic condition, which prevented back-flow of the cells and provided time for cell migration to the infarct area.&lt;/p&gt;
&lt;p&gt;At the three-month follow-up, there was significant improvement in left ventricular performance in the treatment group, reflected by improved cardiac index (by 22%), peak oxygen uptake (by 11%), and oxygen pulse (by 6.3%) (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 for all).&lt;/p&gt;
&lt;p&gt;Exercise capacity increased by 15.4% from baseline, and left ventricular ejection fraction improved from 29.4% at baseline to 36% at three months (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01 for both).&lt;/p&gt;
&lt;p&gt;Both end-diastolic and end-systolic volume decreased from baseline in the treatment group (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 for both).&lt;/p&gt;
&lt;p&gt;There were gains in quality of life as well, with the mean New York Heart Association (NYHA) class dropping from 3.22 to 2.25 (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0167). In the control group, NYHA worsened from 3.06 to 3.5.&lt;/p&gt;
&lt;p&gt;The benefits in the treatment group persisted through one and five years.&lt;/p&gt;
&lt;p&gt;The control group continued to deteriorate through the follow-up points.&lt;/p&gt;
&lt;p&gt;Survival was better in the treatment group than in the control group. Through follow-up, 0.75% of the stem cell-treated patients died each year compared with 3.68% per year among controls (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01).&lt;/p&gt;
&lt;p&gt;&quot;The reason [for the mortality reduction] may be twofold; namely, a decrease in pump failure and a decrease in severe cardiac arrhythmias,&quot; Strauer and his colleagues wrote in their paper.&lt;/p&gt;
&lt;p&gt;Commenting after Strauer&apos;s presentation at the meeting, Francisco Fernandez-Aviles, MD, PhD, of the Hospital General Universitario Gregorio Mara&amp;#241;&amp;#243;n in Madrid, noted the study&apos;s limitations stemming from the open-label nonrandomized design.&lt;/p&gt;
&lt;p&gt;&quot;But it is the largest trial comparing bone marrow cells versus optimal conventional therapy in patients with heart failure due to healed myocardial infarction,&quot; added Fernandez-Aviles, who highlighted many of the positive findings from the study.&lt;/p&gt;
&lt;p&gt;He said that certain steps should be taken before conducting large-scale clinical trials of the stem cell treatment.&lt;/p&gt;
&lt;p&gt;&quot;Translational, randomized, double-blinded, mechanistic studies are necessary to confirm these results, to further elucidate mechanisms, to identify the subgroups of patients with the highest benefit, and to compare different cells and different methods of delivery,&quot; Fernandez-Aviles said.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Strauer reported that he had no conflicts of interest.&lt;/p&gt;&lt;p&gt;Califf disclosed that in his position he oversees research funded by most pharmaceutical companies.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3172"
                     title="Medicare to Cover Smoking Cessation"
                     score="0.012"
                     href="http://www.medpagetoday.com/Pulmonology/Smoking/tb/21901?impressionId=1283457937716"
                     
      &lt;p&gt;WASHINGTON  --  Good news for seniors who want to quit smoking  --  Medicare will now cover tobacco cessation counseling  --  the Department of Health and Human Services announced.&lt;/p&gt;
&lt;p&gt;The new coverage was mandated by the Affordable Care Act (ACA), which contains a number of measures that focus on preventing diseases before they occur, such as paying for cancer screenings, and annual no-cost wellness checkups.&lt;/p&gt;
&lt;p&gt;&quot;For too long, many tobacco users with Medicare coverage were denied access to evidence-based tobacco cessation counseling,&quot; HHS Secretary Kathleen Sebelius said in a statement announcing the new benefit. &quot;Most Medicare beneficiaries want to quit their tobacco use. Now, older adults and other Medicare beneficiaries can get the help they need to successfully overcome tobacco dependence.&quot;&lt;/p&gt;
&lt;p&gt;Of the 46 million Americans who smoke, about 4.5 million are Medicare beneficiaries over age 65, and another million receive Medicare benefits because of a disability, according to HHS.&lt;/p&gt;
&lt;p&gt;Previously, Medicare only covered smoking cessation counseling if a recipient had already been diagnosed with a tobacco-related disease or showed symptoms of such a disease.&lt;/p&gt;
&lt;p&gt;All Medicare beneficiaries already have access to smoking-cessation prescription medication through Medicare&apos;s prescription drug program, Part D.&lt;/p&gt;
&lt;p&gt;Under the new coverage  --  which applies to Medicare Part A and Part B  --  any Medicare beneficiary who smokes will be able to receive counseling from a &quot;qualified physician or other Medicare-recognized practitioner&quot; who can help them quit smoking.&lt;/p&gt;
&lt;p&gt;The benefit will cover up to two separate tobacco cessation attempts per year  --  and each stint in stop-smoking counseling can include up to four sessions.&lt;/p&gt;
&lt;p&gt;&quot;Giving older Americans and persons with disabilities who rely on Medicare the coverage they need for counseling treatments that can aid them in quitting will have a positive impact on their health and quality of life,&quot; said CMS Administrator Don Berwick, MD, in a prepared statement. &quot;As a result, all Medicare beneficiaries now have more help to avoid the painful -- and often deadly -- consequences of tobacco use.&quot;&lt;/p&gt;
&lt;p&gt;HHS will issue guidance in the next few months on a Medicaid provision in the ACA that requires states to help pregnant women quit smoking.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_3127"
                     title="White House Honchos Tout Benefits of Reform"
                     score="0.009"
                     href="http://www.medpagetoday.com/Washington-Watch/Reform/tb/21844?impressionId=1283457937716"
                     
      &lt;p&gt;WASHINGTON  --  Physicians must &quot;embrace rather than resist change&quot; under the new healthcare reform law, three administration officials wrote in an article published in the Aug. 24 issue of the &lt;em&gt;Annals of Internal Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;The most successful physicians will be those who most effectively collaborate with other providers to improve outcomes, care productivity, and patient experience,&quot; wrote Robert Kocher, MD, of the National Economic Council; Ezekiel Emanuel, MD, of the Office of Management and Budget; and Nancy-Ann DeParle, JD, director of the White House&apos;s Office of Health Reform.&lt;/p&gt;
&lt;p&gt;They argue that the Affordable Care Act (ACA) removes barriers that have prevented doctors from fully promoting the health of their patients.&lt;/p&gt;
&lt;p&gt;&quot;While the U.S. certainly has some of the world&apos;s best physicians and health facilities, American medicine fails to deliver reliably high-quality care: We have far too many unplanned readmissions, medication errors, and hospital-acquired infections,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;Kocher, Emanuel, and DeParle said the ACA and the stimulus bill combined address two important barriers to care: information and incentives.&lt;/p&gt;
&lt;p&gt;The stimulus bill (The American Recovery and Reinvestment Act), which was signed into law in February of 2009, provides about $25 billion in incentives for doctors to use electronic health records, allowing physicians to access patient information more quickly and to follow through on prevention recommendations and referrals.&lt;/p&gt;
&lt;p&gt;&quot;One of the nightmares of the healthcare system is paperwork,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;The health reform law will allow doctors to quickly find out whether a particular test is covered, how much the insurance company is paying, and how much the patient will have to pay, providing what the authors call &quot;administrative simplification.&quot;&lt;/p&gt;
&lt;p&gt;&quot;These simple changes are expected to save the government $20 billion over the next decade and save hospitals, physicians, and insurers far more in both cost and frustration,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;The ACA also provides long-term funding for comparative effectiveness research &quot;which should give physicians and patients the clinical and research information they need to make better informed and personalized decisions,&quot; the authors wrote. (The stimulus bill also provided about &lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Reform/12963&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Reform/12963&quot; target=&quot;_blank&quot; title=&quot;Stimulus&amp;#8200;Bill&amp;#8200;Gives&amp;#8200;$1.1&amp;#8200;Billion&amp;#8200;for&amp;#8200;Comparative&amp;#8200;Effectiveness&amp;#8200;Research&quot;&gt;$1 billion&lt;/a&gt; to create a body that would decide which head-to-head trials on drugs, devices, and treatments should be conducted).&lt;/p&gt;
&lt;p&gt;Under the ACA, patient-centered medical homes will allow doctors to &quot;focus on coordinating care&quot; and preventing hospitalizations, something the current fee-for-service system discourages, according to the authors. Plus, they pointed out, programs pilot-testing bundled payments will reward doctors for keeping patients out of the hospital.&lt;/p&gt;
&lt;p&gt;The administration officials pointed out that the ACA includes a 10% payment bonus for certain primary care doctors, and also increases funding by $1.5 billion over five years for the National Health Service Corps to increase the number of primary care doctors, physician assistants, and nurse practitioners.&lt;/p&gt;
&lt;p&gt;They acknowledged that many doctors are disappointed that Congress has failed to enact a fix to the sustainable growth rate (SGR). The most recent short-term &quot;fix&quot; to the SGR, delays a more than 20% cut to Medicare payments to physicians until Dec. 1. The authors said President Obama is committed to replacing the flawed formula  --  which calls for steep cuts in physician pay every year  --  with something more sensible.&lt;/p&gt;
&lt;p&gt;The authors acknowledged that the uncertainty surrounding the SGR is keeping some doctors from embracing the ACA, but &quot;physicians should not let their frustration over the sustainable growth rate distract them from the improvements that healthcare reform delivers to their patients and the profession.&quot;&lt;/p&gt;
&lt;p&gt;The authors predicted that the reforms in the ACA will cause physicians to align themselves with hospitals or physician groups, because &quot;only hospitals or health plans can afford to make the necessary investments in information technology and management skills.&lt;/p&gt;
&lt;p&gt;&quot;Physicians who embrace these changes and opportunities are likely to deliver the greatest benefits to their patients, the health system, and themselves,&quot; the authors concluded.&lt;/p&gt;
&lt;p&gt;&quot;Once we accomplish this transformation, the U.S. system will be more reliable, will be more accessible, and will offer higher-quality and higher-value care. For physicians, this means a profession that is more rewarding, more productive, and better able to realize its moral ideal,&quot; they wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Kocher reported working for the White House&apos;s National Economic Council from January 2009 to July 2010. He now works for the Washington-based consulting firm McKinsey &amp;amp; Company.&lt;/p&gt;&lt;p&gt;DeParle is the director of the White House Office of Health Reform. Deparle reported that  --  prior to joining the administrations  --  she served on the board of directors for Boston Scientific, Medco Health, Cerner Corporation, and DaVita, and held stock options for all four companies. She also served on the board of the Robert Wood Johnson Foundation. She reported being employed by private equity firm CCMP Capital Partners prior to joining the administration. She also reported receiving payments for lectures from Johnson &amp;amp; Johnson and GE Health prior to taking her current position.&lt;/p&gt;&lt;p&gt;Emanuel is the special adviser for health policy at the Office of Managment and Budget. He reported no financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3112"
                     title="CMS to Expand LVAD Coverage"
                     score="0.008"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/Medicare/tb/21822?impressionId=1283457937716"
                     
      &lt;p&gt;Medicare may start to pay for permanent left ventricular assist devices (LVAD) for a broader group of heart failure patients, according to proposed changes in coverage.&lt;/p&gt;
&lt;p&gt;The Centers for Medicare &amp;amp; Medicaid Services (CMS) announced a draft decision removing body size criteria and easing restrictions around the required duration of failed medical therapy and peak oxygen consumption.&lt;/p&gt;
&lt;p&gt;However, the CMS proposal rejected the expansion of reimbursement from patients classified as New York Heart Association (NYHA) Class IV to include Class IIIb patients.&lt;/p&gt;
&lt;p&gt;The changes were requested by the LVAD device manufacturer Thoratec, based on the patient population in its &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/AHA/17064&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/AHA/17064&quot; target=&quot;_blank&quot;&gt;pivotal trial&lt;/a&gt; of long-term therapy with the &lt;a href=&quot;http://www.medpagetoday.com/ProductAlert/DevicesandVaccines/18089&quot; mce_href=&quot;http://www.medpagetoday.com/ProductAlert/DevicesandVaccines/18089&quot; target=&quot;_blank&quot;&gt;HeartMate II&lt;/a&gt; device.&lt;/p&gt;
&lt;p&gt;As LVAD devices became smaller and more portable, they have evolved from being a temporary fix for end-stage heart failure patients awaiting heart transplantation to permanent &quot;destination&quot; therapy for the many patients who aren&apos;t transplant candidates.&lt;/p&gt;
&lt;p&gt;Under the proposed rule changes, CMS would reimburse LVAD as destination therapy when all of the following criteria are met:&lt;ul&gt; &lt;li&gt;NYHA Class IV end-stage ventricular heart failure not suitable for heart transplantation&lt;/p&gt;
&lt;p&gt;&lt;/li&gt; &lt;li&gt;Failure to respond to optimal medical management (including beta-blockers, and ACE inhibitors if tolerated) for
at least 45 of the last 60 days (down from 60 of the prior 90 days in the earlier criteria), being balloon pump dependent for seven days, or IV inotrope dependent for 14 days&lt;/li&gt;&lt;li&gt;&lt;/p&gt;
&lt;p&gt;Left ventricular ejection fraction (LVEF) &amp;lt;25%&lt;/li&gt; &lt;li&gt;Demonstrated functional limitation with a peak oxygen consumption of 14 ml/kg/min (incresed from 12 ml/kg/min in the previous criteria)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Some leading cardiologists had predicted that changes in the devices and &lt;a href=&quot;http://www.medpagetoday.com/Cardiology/CHF/21206&quot; mce_href=&quot;http://www.medpagetoday.com/Cardiology/CHF/21206&quot; target=&quot;_blank&quot;&gt;public awareness&lt;/a&gt; of their use after former Vice President Dick Cheney&apos;s LVAD implantation would lead to an era of increasing use  --  and reimbursement.&lt;/p&gt;
&lt;p&gt;Expanding Medicare coverage even to Class III heart failure patients was suggested by Lishan Aklog, MD, chief of cardiovascular surgery at St. Joseph&apos;s Hospital and Medical Center in Phoenix.&lt;/p&gt;
&lt;p&gt;&quot;For the first time, we have a reliable pump with a low enough complication rate that it can be offered to patients, like Mr. Cheney, who have significant congestive heart failure but are not truly end stage, i.e., in danger of imminent death from organ failure,&quot; he wrote in an e-mail to &lt;em&gt;MedPage Today.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;The CMS, however, was more circumspect in its decision-making.&lt;/p&gt;
&lt;p&gt;Although Class IIIb patients were included in the pivotal trial of destination therapy with HeartMate II, they accounted for only about 20% of the population and there were no published results specific to that subgroup, the CMS draft decision memo noted.&lt;/p&gt;
&lt;p&gt;Moreover, Class IIIb as a subclassification is not widely accepted, and such patients might not be possible to identify accurately enough in routine clinical practice, according to the memo.&lt;/p&gt;
&lt;p&gt;A formal decision is expected in November, after the 30 day public comment period ends.&lt;/p&gt;
&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3111"
                     title="Cost of Prostate Cancer Therapy Varies Widely (CME/CE)"
                     score="0.008"
                     href="http://www.medpagetoday.com//HematologyOncology/tb/21825?impressionId=1283457937716"
                     
      &lt;p&gt;The five-year cost of treating localized prostate cancer varied by as much as 200% depending on the choice of initial therapy, an analysis of an NIH database showed.&lt;/p&gt;
&lt;p&gt;The database, encompassing more than 27,000 cases and cancer-free controls, found that hormone therapy alone or with radiation therapy was the most costly therapy for localized prostate cancer, followed by surgery, radiation therapy alone, and surveillance or watchful waiting. Total costs over five years ranged from about $9,000 to $27,000, according to Claire F. Snyder, PhD, of Johns Hopkins, and colleagues.&lt;/p&gt;
&lt;p&gt;After excluding the last year of life to account for patients who died, the retrospective analysis found that the two hormonal strategies remained the most expensive options for treating localized prostate cancer, Snyder and coauthors wrote in an article published online in the journal &lt;em&gt;Cancer&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;Because most prostate cancer patients will survive their disease, it is important to consider both the short-term and long-term cost implications of the various treatment options,&quot; the researchers concluded. &quot;These data demonstrate that patterns of care vary widely by treatment group.&quot;&lt;/p&gt;
&lt;p&gt;More than 90% of prostate cancers are clinically localized at diagnosis. As a result, overall survival as long as 15 years after diagnosis is about 80%, the authors wrote in their introduction. Because of the high survival rate, long-term follow-up care has a critical role in patient management and cost, they added.&lt;/p&gt;
&lt;p&gt;Multiple treatment options exist for localized prostate cancer, and patients&apos; ages and clinical characteristics span a wide range. More than one treatment option might be appropriate for any given patient, the authors noted.&lt;/p&gt;
&lt;p&gt;Although treatment options for prostate cancer involve obvious cost considerations, comparative data regarding the options remain scarce. To address the lack of data, Snyder and colleagues performed a retrospective, longitudinal cohort study, using data from the Surveillance, Epidemiology, and End Results (SEER) program.&lt;/p&gt;
&lt;p&gt;The analysis included men ages 66 and older, in Medicare fee for service plans, with diagnoses of localized prostate cancer in the year 2000, and followed for five years. Each patient was matched with a cancer-free control.&lt;/p&gt;
&lt;p&gt;The final analysis included 13,769 patients with localized prostate cancer and an identical number of noncancer controls.&lt;/p&gt;
&lt;p&gt;On the basis of care received during the first nine months after diagnosis, the cancer patients were grouped by initial treatment: watchful waiting (2,805), radiation therapy alone (2,582), hormonal therapy alone (2,190), hormonal therapy plus radiation therapy (3,992), and surgery (2,200).&lt;/p&gt;
&lt;p&gt;The mean age of the patients ranged from 70.5 in the surgery group to 78.9 in the hormone therapy-only group.&lt;/p&gt;
&lt;p&gt;First-year costs were lowest for watchful waiting ($4,270) and highest for the hormone-radiation group ($17,474).&lt;/p&gt;
&lt;p&gt;The total five-year costs were as follows:&lt;ul&gt; &lt;li&gt;Watchful waiting, $9,130&lt;/li&gt; &lt;li&gt;Radiation therapy only, $15,589&lt;/li&gt; &lt;li&gt;Surgery, $19,214&lt;/li&gt; &lt;li&gt;Hormone-radiation, $25,097&lt;/li&gt; &lt;li&gt;Hormonal only, $26,896&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Almost a fourth of men in the surgery group also received radiation therapy, hormonal therapy, or both. Limiting the analysis to men who had only surgery resulted in first-year costs totalling $13,730 and five-year costs adding up to $16,327.&lt;/p&gt;
&lt;p&gt;Excluding the last 12 months of therapy made hormonal-radiation therapy the most costly ($23,488), followed by hormone only ($23,199).&lt;/p&gt;
&lt;p&gt;While active surveillance is increasingly used in men with clinically insignificant cancer and a low risk for progression, the researchers found that men in the watchful waiting group had a greater number of physician visits overall, and urologist visits in particular.&lt;/p&gt;
&lt;p&gt;Limitations of the study included the short follow-up period of five years. Other limitations included use of the SEER-Medicare database, so the study sample did not include younger men or those in Medicare managed care.&lt;/p&gt;
&lt;p&gt;The authors also noted that their study may be subject to some misclassification bias because the team relied on claims data to assign men to treatment groups; therefore, they wrote, missing or inaccurate codes may have resulted in some men being assigned to the wrong treatment group.&lt;/p&gt;
&lt;p&gt;Also, some men may have taken more than nine months to decide on treatment; men who received no active treatment in the first nine months after diagnosis were considered to have &quot;watchful waiting.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Although we made an effort to make the treatment groups as homogeneous as possible, heterogeneity in treatments received remains, with for example various lengths of hormonal treatment,&quot; the team wrote.&lt;/p&gt;
&lt;p&gt;They also noted that cost estimates included only direct medical costs and not other direct costs or any indirect costs, and was not designed as a cost-effectiveness or comparative effectiveness analysis.&lt;/p&gt;
&lt;p&gt;In the end, cost is only one consideration in selecting treatment for localized prostate cancer; quality of life and other outcomes are also important.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors reported that they had no relevant disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>