– Hawaii is a bargain
Variations in the cost of delivering radiation therapy to Medicare beneficiaries for breast, lung, and prostate cancer does not depend on either patient or disease-related factors but rather is mostly driven by the location from which that care is delivered and individual patient providers.
Using data from the SEER-Medicare linked database, investigators found that the median cost of a course of radiation therapy delivered to 55,288 patients was $8,600 (Interquartile range: $7,300-$10,300) for breast cancer; $9,000 ($7,500-$11,100) for lung cancer, and $18,000 ($11,300-$25,500) for prostate cancer.
Factors associated with the patient or the patient’s tumor accounted for less than 3% of the total variation in the cost of radiation therapy for all three cancer types.
In contrast, factors unrelated to the patient, including the year of diagnosis, where patients received treatment and individual patient providers, accounted for 44% of the variation in cost for radiation therapy for breast cancer, 43% of the variation in cost for lung cancer, and 61% of the variation in cost for prostate cancer.
The type of radiation therapy patients received also accounted for a large portion of the variation in treatment costs, ranging from 15% for prostate cancer to 27% for breast and 30% for lung cancer.
“In an efficient payment system, reimbursement of health care services should vary based on factors related to the patient, disease, or patient case complexity,” Anthony Paravati, MD, Moores Cancer Center, University of California San Diego, La Jolla, California and colleagues write in the Journal of Oncology Practice.
“The geographic region of treatment delivery affected the cost of radiation therapy,” the authors note, “with the lowest cost in Hawaii and the highest cost in Washington State.”
“The key finding of this study — that variability in Medicare reimbursement for radiotherapy does not depend on patient or disease-related factors — suggests substantial inefficiency with the current Medicare reimbursement framework.”
A spokesperson for the American Society for Radiation Oncology (ASTRO) told Medpage Today that ASTRO leadership plans to submit a written response to the findings. Although ASTRO offered no specific comments at this point, the spokesperson noted that the Paravati study used Medicare data through 2009, whereas complete data now extend through 2013.
The SEER program, supervised by the National Cancer Institute, represents a collection of individual cancer registries across the US covering 28% of the U.S. population.
Investigators focused on breast, prostate, and lung cancers in this particular study because they are the most common malignancies treated with radiotherapy in this patient cohort.
Patients with breast cancer who underwent breast-conserving surgery and those with lung or prostate cancer receiving definitive radiotherapy without surgery were included in the analysis.
In contrast, radiation delivered in the inpatient setting was not included because of the inability to separate reimbursement for inpatient radiation therapy from other charges incurred duration hospitalization.
By Pam Harrison
Original article: http://www.medpagetoday.com/Radiology/TherapeuticRadiology/53119?xid=nl_mpt_special_reports_2015-08-04&eun=g5542349d11r