Researchers have noted that physicians often respond to financial incentives. Recently, when Medicare altered its reimbursement plan for hormonal treatment for men with prostate cancer, the number of people who used the treatment is noted to have reduced substantially.

However those benefitted a lot from the treatment – androgen-deprivation therapy continued to take it, researchers noted in the New England Journal of Medicine.

Study author Dr. Vahakn Bedig Shahinian, an assistant professor of internal medicine at the University of Michigan, in Ann Arbor, noted that cuts across a variety of medical scenarios having nothing to do with prostate cancer.

Doctors say this could also occur in other treatments, even in other areas of prostate cancer. “For instance, proton beam radiation therapy reimburses very well so there are certain medical centers that are really pushing it," agreed Dr. Judd W. Moul, chief of the division of urologic surgery at Duke University Medical Center in Durham, N.C.

"Another classic example is imaging," Moul said. "CAT scans reimburse pretty well so a lot of doctors put CAT scan units into their offices. That's a profit center."

The reimbursement for the androgen-deprivation therapy was slashed by 50 per cent, by the Medicare Modernization Act that went into effect in 2004 and 2005.

Researchers note that the number of takers was higher when reimbursement rates were much higher, in the 1990s.
Moul said "There was a significant difference between what the doctors were able to buy the drugs for and what Medicare would cover when they were administered. The bottom line is they were very profitable for the physicians."

Dr. Shahinian tried to analyze the Act and studied medical records of about 55,000 men who were diagnosed with prostate cancer between 2003 and 2005. He categorized the patients based on the level at which their tumors had grown.

Reports suggest that unnecessary use of androgen-deprivation therapy declined from 38.7 percent in 2003 to 30.6 percent in 2004, then to 25.7 percent in 2005. Gray-zone use declined in 2005, but not the prior year.

Authors feel there could be other reasons contributing to the decline, including spotting adverse effects of the treatment.

Researchers were not sure if their findings will change the health care system in the U.S.

"It's very subjective. There are no hard-core guidelines. There are suggestions," Moul said. "In general, you want to use hormone therapy in higher-risk men who have worse disease but there's a fairly significant gray zone," he pointed out.

"There's probably many, many areas where the system could be tightened up, where we could save money but the downside is going to be a lot of individual patients who are going to be mad because they can't get what they want to get," he added.