Wide variations in radiation therapy costs illustrate that factors associated with individual patients or their tumors have little to do with the actual cost of treatment, 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—the year of diagnosis, treatment location, and individual providers—accounted for a large chunk of the variation.
"The main finding was that the cost didn't correlate with the patient or the characteristic of the tumor," says the study's senior author James Murphy, MD, assistant professor at UC San Diego School of Medicine and radiation therapist at Moores Cancer Center at UC San Diego Health.
Murphy says he and his colleagues expected the correlation to be low but, "we didn't think it was actually going to be that low," he says. "That was probably the most surprising finding."
James Murphy, MD |
Getting a handle on what's driving the variation in costs was the impetus for the study.
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"Radiation oncology is a small specialty in the scope of healthcare but the cost associated with treatment is relatively high compared with other services patients receive," Murphy says.
In fact, 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 those 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're the most common ones that are treated with radiation therapy.
The researchers found that the median cost of a course of radiation therapy—estimated from Medicare reimbursements—was $8,600 ($7,300 to $10,300) for breast cancer, $9,000 ($7,500 to $11,100) for lung cancer, and $18,000 ($11,300 to $25,500) for prostate cancer.
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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 reports. 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 says that this study and others like it potentially shows inefficiency in the healthcare system, and provide some impetus to move away from the current fee-for-service-based reimbursement schema. He adds that evidence for that conclusion is coming from a lot of different angles.
But "what a better option is, I don't really know," he says, noting that ideally researchers should test out different policies to see what's best.
He adds that parsing out cost and quality is difficult to do in cancer care and radiation oncology.
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"Cancer just by its nature is a little more fragmented," he says. For instance, patients might get radiation and chemotherapy at different facilities. Also, defining outcomes in cancer care can be complicated, and once they are defined, those outcomes are sometimes measured over several years. In addition, adverse effects, such as radiation toxicity from treatment, can take years to manifest.
"Trying to reimburse for patients today for outcomes happening years down the road is complicated," Murphy says.
He says that there's been quite a lot of interest in this study; "Anytime people start asking about reimbursement and cost it's always of interest."
And there are many stakeholders.
Murphy notes 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 healthcare leaders should pay special attention.
Others are also closely examining the cost of cancer care. Earlier this summer, the American Society of Clinical Oncology (ASCO) published an initial version of a conceptual framework for assessing the value of new cancer treatment options based on clinical benefit, side effects, and cost. ASCO's framework is open for public comment through August 21.
"My personal opinion is that it's really promising that ASCO is taking this on," Murphy says.
Finally, there are the patients themselves to consider, who Murphy suspects are "not at all" aware of the many differing factors that could lead to variations in the cost of their radiation therapy.
"I don't think patients are even aware of this at all," he says. "The patients are at a distinct disadvantage when it comes to understanding the cost of healthcare."
Alexandra Wilson Pecci is an editor for HealthLeaders.
