The case for radiotherapy in a Value based environment

Johnstone, Peter A.S.; Peneguy, Susan; Showalter, Timothy N.; Yu, James B.

doi:10.1016/j.rpor.2019.01.006

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…These reasons include greater access to larger teams and peer training, onsite didactics, journal access, acquisition of capital, and potentially different financial incentives for clinicians . Other barriers to adoption include the current misalignment of financial reimbursement to support the resources required for ultrahypofractionation . These additional resources include but are not limited to need for optimal image guidance quality, use of 6 degrees of freedom, potential for enhanced immobilization devices, more precise quality assurance technology, time needed for image registrations to define organs at risk (ie, urethra), additional time for quality assurance, and requirement of the presence of physics and physicians for each fraction of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 Other barriers to adoption include the current misalignment of financial reimbursement to support the resources required for ultrahypofractionation. 8,13,15 These additional resources include but are not limited to need for optimal image guidance quality, use of 6 degrees of freedom, potential for enhanced immobilization devices, more precise quality assurance technology, time needed for image registrations to define organs at risk (ie, urethra), additional time for quality assurance, and requirement of the presence of physics and physicians for each fraction of treatment. While SBRT functionality is standard on new fully equipped linear accelerators, the mean age of active linear accelerators in the US is estimated to be 14 years, and acquisition of a new machine and construction can exceed $4 million.…”

Section: Discussionmentioning

confidence: 99%

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Increasing Use of Shorter-Course Radiotherapy for Prostate Cancer

Yu,

Sun,

Jia

et al. 2023

JAMA Oncol

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ImportanceRandomized clinical trials have demonstrated the noninferiority of shorter radiotherapy (RT) courses (termed hypofractionation) compared with longer RT courses in patients with localized prostate cancer. Although shorter courses are associated with cost-effectiveness, convenience, and expanded RT access, their adoption remains variable.ObjectiveTo identify the current practice patterns of external beam RT for prostate cancer in the US.Design, Setting, and ParticipantsThis cohort study obtained data from the National Cancer Database, which collects hospital registry data from more than 1500 accredited US facilities on approximately 72% of US patients with cancer. Patients were included in the sample if they had localized prostate adenocarcinoma that was diagnosed between 2004 and 2020 and underwent external beam RT with curative intent. Analyses were conducted between February and March 2023.ExposuresRadiotherapy schedules, which were categorized as ultrahypofractionation (≤7 fractions), moderate hypofractionation (20-30 fractions), and conventional fractionation (31-50 fractions).Main Outcomes and MeasuresLongitudinal pattern in RT fractionation schedule was the primary outcome. Multivariable logistic regression was performed to evaluate the variables associated with shorter RT courses. Covariables included age, National Comprehensive Cancer Network risk group, rurality, race, facility location, facility type, median income, insurance type or status, and Charlson-Deyo Comorbidity Index.ResultsA total of 313 062 patients with localized prostate cancer (mean [SD] age, 68.8 [7.7] years) were included in the analysis. There was a temporal pattern of decline in the proportion of patients who received conventional fractionation, from 76.0% in 2004 to 36.6% in 2020 (P for trend &lt;.001). From 2004 to 2020, use of moderate hypofractionation increased from 22.0% to 45.0% (P for trend &lt;.001), and use of ultrahypofractionation increased from 2.0% to 18.3% (P for trend &lt;.001). By 2020, the most common RT schedule was ultrahypofractionation for patients in the low-risk group and moderate hypofractionation for patients in the intermediate-risk group. On multivariable analysis, treatment at a community cancer program (compared with academic or research program; odds ratio [OR], 0.54 [95% CI, 0.52-0.56]; P &lt; .001), Medicaid insurance (compared with Medicare; OR, 1.49 [95% CI, 1.41-1.57]; P &lt; .001), Black race (compared with White race; OR, 0.90 [95% CI, 0.87-0.92]; P &lt; .001), and higher median income (compared with lower median income; OR, 1.28 [95% CI, 1.25-1.31]; P &lt; .001) were associated with receipt of shorter courses of RT.Conclusions and RelevanceResults of this cohort study showed an increase in the use of shorter courses of RT for prostate cancer from 2004 to 2020; a number of social determinants of health appeared to be associated with reduced adoption of shorter treatment courses. Realignment of reimbursement models may be necessary to enable broader adoption of ultrahypofractionation to support technology acquisition costs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Increasing Use of Shorter-Course Radiotherapy for Prostate Cancer

Yu,

Sun,

Jia

et al. 2023

JAMA Oncol

Self Cite

View full text Add to dashboard Cite

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Drivers of Medicare Spending: A 15-Year Review of Radiation Oncology Charges Allowed by the Medicare Physician/Supplier Fee-for-Service Program Compared With Other Specialties

Mokhtech

Laird

Maroongroge

et al. 2021

International Journal of Radiation Oncology*Biology*Physics

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Costs Around the First Year of Diagnosis for 4 Common Cancers Among the Privately Insured

Shih

Giordano

Yao

et al. 2022

JNCI: Journal of the National Cancer Institute

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Background We estimated trends in total and out-of-pocket (OOP) costs around the first year of diagnosis for privately insured nonelderly adult cancer patients. Methods We constructed incident cohorts of breast, colorectal, lung, and prostate cancer patients diagnosed between 2009 and 2016 using claims data from the Health Care Cost Institute. We identified cancer-related surgery, intravenous (IV) systemic therapy, and radiation and calculated associated total and OOP costs (in 2020 US dollars). We assessed trends in health-care utilization and cost by cancer site with logistic regressions and generalized linear models, respectively. Results The cohorts included 105 255 breast, 23 571 colorectal, 11 321 lung, and 59 197 prostate cancer patients. For patients diagnosed between 2009 and 2016, total mean costs per patient increased from $109 544 to $140 732 for breast (29%), $151 751 to $168 730 for lung (11%) or $53 300 to $55 497 for prostate (4%) cancer were statistically significant. Increase for colorectal cancer (1%, $136 652 to $137 663) was not statistically significant (P = .09). OOP costs increased to more than 15% for all cancers, including colorectal, to more than $6000 by 2016. Use of IV systemic therapy and radiation statistically significantly increased, except for lung cancer. Cancer surgeries statistically significantly increased for breast and colorectal cancer but decreased for prostate cancer (P < .001). Total costs increased statistically significantly for nearly all treatment modalities, except for IV systemic therapy in colorectal and radiation in prostate cancer. Conclusions Rising costs of cancer treatments, compounded with greater cost sharing, increased OOP costs for privately insured, nonelderly cancer patients. Policy initiatives to mitigate financial hardship should consider cost containment as well as insurance reform.

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The case for radiotherapy in a Value based environment

Cited by 3 publications

References 23 publications

Increasing Use of Shorter-Course Radiotherapy for Prostate Cancer

Increasing Use of Shorter-Course Radiotherapy for Prostate Cancer

Drivers of Medicare Spending: A 15-Year Review of Radiation Oncology Charges Allowed by the Medicare Physician/Supplier Fee-for-Service Program Compared With Other Specialties

Costs Around the First Year of Diagnosis for 4 Common Cancers Among the Privately Insured

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