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Radiation Costs, Individual Cancers Poorly Correlated

Factors associated with patients or their tumors have little bearing on treatment costs, researchers find

Factors associated with individual patients or their particular tumors hold little sway in determining the cost variations in radiation therapy for cancer patients, according to a recent study of Medicare patients.

In fact, those factors accounted for less than 3% of the variation in the cost. Instead, factors having nothing to do with the patients themselves — e.g., the year of diagnosis, the treatment location, and the individual providers — accounted for a large part of the cost variations.

“The main finding was that the cost didn’t correlate with the patient or the characteristic of the tumor,” said senior author James Murphy, MD, of the University of California–San Diego School of Medicine.

Getting a handle on what’s driving the variation in costs was the impetus for the study.

“Radiation oncology is a small specialty within the scope of health care, but the cost associated with treatment is relatively high compared with other services patients receive,” Murphy said.

The total cost of radiation therapy for the 55,288 patients in the study was estimated to be more than $831 million. The researchers identified patients in the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database who were diagnosed with breast, lung, or prostate cancer between 2004 and 2009. These cancers were chosen because they are most commonly treated with radiation therapy.

The researchers found that the median costs of a course of radiation treatment — estimated from Medicare reimbursements — were $8,600 (range: $7,300 to $10,300) for breast cancer, $9,000 (range: $7,500 to $11,100) for lung cancer, and $18,000 (range: $11,300 to $25,500) for prostate cancer.

The cost variations that were based on factors “including practice type, geography, and individual radiation therapy provider, accounted for a substantial proportion of the variation in cost, ranging from 44% with breast, 43% with lung, and 61% with prostate cancer,” the study reported. For instance, radiation therapy was least expensive in Hawaii and most expensive in Washington state.

The study also found that “the cost of radiation therapy increased from 2004 through 2007, decreased uniformly across all disease sites between 2007 and 2008, and resumed an upward trend again in 2009.”

Murphy said that this study and others like it potentially show inefficiency in the health care system, and provide an impetus to move away from the current fee-for-service-based reimbursement schema.

Murphy also noted that radiation oncology is a high-revenue-generating specialty, and because there could be major changes in the way it’s reimbursed in the future, hospital and other health care leaders should pay special attention.

Others are also closely examining the cost of cancer care. Earlier this summer, the American Society of Clinical Oncology published an initial framework for assessing the value of new cancer treatment options based on clinical benefits, adverse effects, and cost.

Source: HealthLeaders Media; August 20, 2015.

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