Medicare confirmed on Thursday that it would pay for Provenge, the prostate cancer drug whose $93,000 price had set off debate about the cost of cancer treatments.

The Centers for Medicare & Medicaid Services said in a final decision that the evidence was adequate to conclude that Provenge “improves health outcomes for Medicare beneficiaries’’ and was therefore “reasonable and necessary” for their treatment.

However, reimbursement would be only for men who matched the criteria in the drug’s label, meaning they had few or no symptoms and cancer that had spread beyond the prostate gland and was no longer controlled by hormone therapy.

The final decision follows a yearlong review and confirms a tentative decision announced three months ago. Most men with prostate cancer are covered by Medicare.

Provenge, developed by Dendreon, based in Seattle, is one of a series of new prostate cancer drugs that have been shown to prolong men’s lives and in some cases relieve symptoms, but whose costs are raising questions.

The announcement that Medicare would undertake the a “national coverage determination’’ had drawn an outcry from some men with the disease and investors in Dendreon, who saw it as a warning by Medicare about high prices.

But Medicare officials denied that cost was the issue. One reason for the review, they said, was that it was unclear if Provenge was a drug or a treatment process.

Provenge, which was approved by the Food and Drug Administration in April 2010, is the first cancer treatment that works by training a patient’s own immune system to fight the disease. White blood cells are taken from each man, processed by Dendreon, and then infused back into his body.

In its largest clinical trial, men who received Provenge lived a median of 25.8 months compared with 21.7 months for those who got a placebo.

By Laura Landro

For patients with varicose veins, a number of new less invasive treatments are replacing a difficult surgical procedure known as stripping that was often the only solution in the past, according to the Health Matters column in today?s Next section.

Growing in popularity are lasers and radiofrequency ablation to destroy veins, which cost $2,500 to $3,000 per procedure, compared with about $1,200 to $1,500 for surgical stripping, according to the American American Society for Dermatologic Surgery . While patients may have to pay out of pocket for any procedures that are strictly for cosmetic reasons — varicose veins can be unsightly in some cases without being painful or dangerous ? there is increasing recognition that varicose veins can cause serious complications such as bleeding veins, leg swelling and dangerous leg ulcers, making it more likely that insurers and the federal Medicare program will cover treatment as ?medically necessary. This is especially true if more-conservative treatment ? such as the use of compression stockings ? has failed, and if symptoms of varicose veins significantly affect daily living.

Suresh Vedantham, professor radiology and surgery at Washington University School of Medicine and vice president of the Venous Disease Coalition, tells the Health Blog that 70% to 80% of patients who seek treatment for varicose veins have ?life-impairing, significant symptoms? such as swelling, fatigue and burning symptoms that interfere with activity. ?Only a minority come in for strictly cosmetic reasons,? Dr. Vedantham says, and many who wait too long for treatment present with permanent skin changes, open sores and other problems ?that are very challenging to treat.?

An injectible drug, polidocanol, sold under the brand name Asclera and approved for use in the U.S. last summer, costs about $250 to $500. but it is used primarily for smaller spider veins that appear on the face as well as the legs, and for smaller reticular veins on the legs, as opposed to larger saphenous veins that can cause the most significant problems for patients.

Though the exact cause of varicose veins isn?t known, they develop when one-way valves in the veins that prevent the blood from flowing backward stop working properly, so blood pools in the superficial veins under the surface of the skin and causes them to get larger and less elastic.

Robert Weiss, a past president of the ASDA who heads the of the Maryland Laser, Skin and Vein Institute in Baltimore, says that when stripping was the only option ? pulling the veins out with a wire inserted in the skin through an incision ? many patients went untreated for fear of the procedure. when they hit their 60s, Dr. Weiss says, such patients often ended up with chronic venous disease, with valves in their leg veins that don?t function properly and impaired circulation of blood in the leg veins.

art source: iStockphoto