Session: MP21: Diversity, Equity & Inclusion: Health Equity & Outcomes II
MP21-09: Do Insurance Payor Type and Race Predict Decreased Access to Holmium laser Enucleation of the Prostate? A Nationwide Analysis of Academic Centers
Introduction: Recent literature supports that holmium laser enucleation of the prostate (HoLEP), compared to traditional transurethral procedures, has improved outcomes in hemostasis, urinary symptoms, and complication rates. This study sought to evaluate the utilization of HoLEP and thulium laser enucleation of the prostate (ThuLEP) and associated patient characteristics. Methods: The Clinical Practice Solutions Center (CPSC) database was queried to identify patients with BPH treated surgically from 2018 to 2022. Men 40 years or older who had procedural intervention for BPH based upon ICD-10 and CPT codes specific to HoLEP, ThuLEP, transurethral resection of the prostate (TURP), laser vaporization, laser coagulation, transurethral incision, microwave thermotherapy, radiofrequency thermotherapy, water vapor thermotherapy, and prostatic urethral lift surgeries. Men with a diagnosis of prostate cancer were excluded. Patient characteristics were analyzed, including age, race, insurance, and region. Results: The analysis included data from 88 academic centers. A total of 63,145 patients underwent surgery, of which 42.4% had a TURP versus 19.8% had a HoLEP/ThuLEP performed. Regionally, patients in the Midwest had a significantly higher probability of receiving HoLEP/ThuLEP. The racial/ethnic demographics of the study population included: 58.8% White, 10.6% Black, 3.6% Hispanic, 2.2% Asian, 0.8% Native or Alaskan Native Americans, and 24% other/unknown patients. A relative risk model comparing the probability of undergoing HoLEP/ThuLEP between races demonstrated that white patients were more likely to undergo laser enucleation compared to any other group except Hispanic patients (Table 1). Commercially insured patients had a 65% higher chance of undergoing a HoLEP/ThuLEP than Medicaid patients. Medicare beneficiaries compared to Medicaid were 83% more likely and 11% more likely than commercially insured patients to have a laser enucleation surgery performed. Conclusions: Medicaid insurance and non-White race/ethnicity were associated with significantly less utilization of HoLEP. Work needs to be done to decrease the evident disparities in provision of this cutting-edge urologic procedure as differences may be due to counseling or regional access. SOURCE OF Funding: n/a
