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Diagnostic Imaging Uses 57% of the Cost of Cancer Care

Cheryl Clark, for HealthLeaders Media, April 28, 2010

The cost of treating cancer has been going up, but the cost of imaging to diagnose and stage those with the disease is skyrocketing, according to a report.

In fact, imaging tests in cancer care for Medicare patients accounted for 57% of all cancer costs in 2004, suggesting that the study population "represented the majority of cancer costs borne by Medicare beneficiaries."

Positron emission tomography scans increased the most, and in each of six types of cancer studied, from an average annual rate of 35.9% to 53.6% between 1999 and 2006, the period studied, says the report from Michaela Dinan, Kevin Schulman, MD, and colleagues from the Duke Clinical Research Institute in Durham, NC. Their research is reported in today's edition of the Journal of the American Medical Association.

Bone studies increased by 6.3% to 20%; echocardiograms by 5% to 7.8%; magnetic resonance imaging, 4.4% to 11.5%, and ultrasound, .7% to 7.4%.

"Beneficiaries with lung cancer and beneficiaries with lymphoma incurred the largest overall imaging costs, exceeding a mean of $3,000 per beneficiary within two years of diagnosis," the report says.

The cost of all cancer care increased 1.8% to 4.6% per year, but imaging grew at 5.1% to 10.3% per year.

The authors noted that while there "is little debate that imaging use has increased rapidly, there is less agreement about what the increases mean for Medicare beneficiaries and the Medicare program. Concerns have include d the high profit margins associated with imaging, payment incentives for imaging and the notion that rapid adoption of new medical devices and imaging technologies may be influenced by U.S. Food and Drug Administration approval requirements that are less stringent than requirements for new drugs," the authors wrote.

"Advanced imaging services are among the most frequent sources of competition among hospitals and physicians, and the use of advanced imaging appears to be additive in nature rather than a substitute for conventional imaging methods."

The researchers used Medicare claims data, sampling 5% of beneficiaries aged 67 or older for 1997 through 2008, including inpatient, outpatient, carrier, skilled nursing facility, home health, hospice and durable medical equipment claims for that period included under both Part A and Part B. Claims were counted in the two-year period following disease onset.

Patients with six types of cancer were included: breast and colorectal cancer, leukemia, lung cancer, non-Hodgkin lymphoma and prostate cancer.


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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