Evidence supports the value of shorter, similarly efficacious, and potentially more cost-effective hypofractionated radiotherapy (RT) regimens in many clinical scenarios for breast cancer (BC) and prostate cancer (PC). However, practice patterns vary considerably. We used the most recent Centers for Medicare and Medicaid Services data to assess trends in RT cost and practice patterns among episodes of BC and PC.
We performed a retrospective cohort analysis of all external beam episodes RT (EBRT) for BC and PC from 2015-2019 to assess predictors of short-course RT (SCRT) utilization and calculate spending differences. Multivariable logistic regression defined adjusted odds ratios of receipt of SCRT over longer-course RT (LCRT) by treatment modality, age, year of diagnosis, type of practice, as well as the interaction between year and treatment setting. Medicare spending was evaluated using multivariable linear regression controlling for duration of RT regimen (SCRT vs LCRT) in addition to the covariables above.
Of 143,729 BC episodes and 114,214 PC episodes, 80,106 (55.73%) and 25,955 (22.72%) were SCRT regimens, respectively. Median total spending for SCRT regimens among BC episodes was $9,418 (IQR, $7,966-$10,982) vs. $13,601 (IQR, $11,814-$15,499) for LCRT. Among PC episodes, median total spending was $6,924 (IQR, $4,509-$12,905) for SBRT, $18,768 (IQR, $15,421-$20,740) for moderate hypofractionation, and $27,319 (IQR, $25,446-$29,421) for LCRT. On logistic regression, receipt of SCRT was associated with older age among both BC and PC episodes, as well as treatment at hospital-affiliated over freestanding sites (p<0.001 for all).
In this evaluation of BC and PC RT episodes from 2015-2019, we found that shorter-course RT resulted in lower costs vs. longer-course RT. SCRT was also more common in hospital-affiliated sites. Future research focusing on potential payment incentives encouraging SCRT when clinically appropriate and applicable in the two most common cancers treated with RT will be valuable as the field continues to prospectively evaluate cost-effective hypofractionation in other disease sites.
International journal of radiation oncology, biology, physics. 2023 Dec 08 [Epub ahead of print]
Tej A Patel, Bhav Jain, Neha Vapiwala, Fumiko Chino, Kathryn R Tringale, Brandon A Mahal, Kosj Yamoah, Sean N McBride, Miranda B Lam, Anne Hubbard, Paul L Nguyen, Edward Christopher Dee
University of Pennsylvania, Philadelphia, PA, USA., Department of Health Policy, Stanford University School of Medicine, Stanford, California, USA., Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA., Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA., Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA., Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Department of Health Policy, American Society for Radiation Oncology, Arlington, VA, USA., Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: .