CONFIRMATORY testing for men with low-risk prostate cancer increased steadily in recent years, but a payment incentive program was not linked to a statistically significant improvement in its use, according to a large cohort study.
The investigation analyzed data from 6,609 men diagnosed with low-risk prostate cancer across the Michigan Urological Surgery Improvement Collaborative between 2017 and 2022. Confirmatory testing, which can include repeat biopsy, prostate MRI, or genomic testing, is recommended in guidelines to identify more aggressive cancers that may warrant treatment rather than continued surveillance. However, more than half of men historically have not received confirmatory testing, highlighting an important gap in care.
To address this, a multifaceted intervention was introduced that included physician education and a payment incentive. The commercial payer sponsoring the program agreed to provide enhanced reimbursement if practices reached a benchmark of at least 45% of patients completing confirmatory testing within six months of diagnosis.
The study found that confirmatory testing completion rose from 44.6% of eligible patients in 2017 to 64.3% in 2022, a significant improvement over time. During the specific payment incentive period from April 2018 through May 2019, the predicted probability of confirmatory testing increased by 7.5%. However, this change narrowly missed statistical significance, with an odds ratio of 1.43 (95% CI: 0.99–2.09; P=0.06).
Researchers concluded that while overall uptake of confirmatory testing has improved, the incentive program itself did not generate a robust increase. The findings suggest that payer–physician collaboration may help advance care quality, but also underscore the complexities of designing effective payment models in prostate cancer management.
Reference: Srivastava A et al. A Payment Incentive to Improve Confirmatory Testing in Men With Prostate Cancer. JAMA Netw Open. 2025;8(9):e2530624.
