Prostate Ca radiation therapy cost drivers analyzed

August 24, 2015

The cost of radiation therapy for prostate cancer in the United States varies substantially, and most of the variation is accounted for by factors that are not related to the patient or tumor, according to the results of a study published online in Journal of Oncology Practice (Aug. 11, 2015).

The cost of radiation therapy for prostate cancer in the United States varies substantially, and most of the variation is accounted for by factors that are not related to the patient or tumor, according to the results of a study published online in Journal of Oncology Practice (Aug. 11, 2015). 

The investigation, undertaken by researchers from the University of California, San Diego and Peking University in Beijing, identified patients within the Surveillance, Epidemiology, and End Results database who were diagnosed with prostate, breast, or lung cancer between 2004 and 2009. Based on Medicare reimbursements, they analyzed costs of radiation therapy, and then used multivariable linear regression models to explore the effects of patient, tumor, and radiation therapy provider characteristics on cost variation.

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For the prostate cancer cohort, the median cost of radiation therapy was $18,000, and the interquartile range was $11,300 to $25,500. Less than 3% of the variation in radiation therapy cost for prostate cancer was accounted for by patient- or tumor-related factors, while 61% of the variation was related to practice type, geography, and individual radiation therapy provider.

The study was conducted recognizing that radiation therapy is a major source of health care spending for patients with cancer-the total cost of radiation therapy for the 55,288 patients included in the study exceeded $831 million-and recognizing that understanding the sources of variability in the cost of radiation therapy is critical to evaluating the efficiency of the Medicare reimbursement system.

As noted by first author Anthony Paravati, MD, “Such insights are likely to shape policy reforms in the near-future.”

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The authors also pointed out the need for future research exploring the potential association between cost of radiation therapy and quality of care, a critical issue that was not part of the study. Urology Times Editorial Consultant J. Brantley Thrasher, MD, agreed.

“We might be able to justify higher cost for radiation therapy that results in a better quality treatment and better outcomes,” said Dr. Thrasher, who was not involved in the study.

Commenting on the research, Dr. Thrasher also noted that the magnitude of the variability in total costs was not too surprising, but the fact that tumor and patient characteristics were very small drivers of total costs was unexpected.

“One would think that tumor characteristics would be an important variable influencing the type and dose of radiation therapy used for prostate cancer,” he said.

Dr. Thrasher also observed it would be helpful to have more details about potential sources of cost variation.

“It would be nice to know if a more expensive delivery system is used in certain geographic regions, if large groups of urologists generally deliver higher or lower cost radiation therapy, and if physician ownership is a cost driver,” he said.

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