title: The adoption of new adjuvant radiation therapy modalities among Medicare beneficiaries with breast cancer: clinical correlates and cost implications.
abstract: OBJECTIVE
  New radiation therapy modalities have broadened treatment options for older women with breast cancer, but it is unclear how clinical factors, geographic region, and physician preference affect the choice of radiation therapy modality.
  
  
  METHODS
  We used the Surveillance, Epidemiology, and End Results-Medicare database to identify women diagnosed with stage I-III breast cancer from 1998 to 2007 who underwent breast-conserving surgery. We assessed the temporal trends in, and costs of, the adoption of intensity modulated radiation therapy (IMRT) and brachytherapy. Using hierarchical logistic regression, we evaluated the relationship between the use of these new modalities and patient and regional characteristics.
  
  
  RESULTS
  Of 35,060 patients, 69.9% received conventional external beam radiation therapy (EBRT). Although overall radiation therapy use remained constant, the use of IMRT increased from 0.0% to 12.6% from 1998 to 2007, and brachytherapy increased from 0.7% to 9.0%. The statistical variation in brachytherapy use attributable to the radiation oncologist and geographic region was 41.4% and 9.5%, respectively (for IMRT: 23.8% and 22.1%, respectively). Women undergoing treatment at a free-standing radiation facility were significantly more likely to receive IMRT than were women treated at a hospital-based facility (odds ratio for IMRT vs EBRT: 3.89 [95% confidence interval, 2.78-5.45]). No such association was seen for brachytherapy. The median radiation therapy cost per treated patient increased from $5389 in 2001 to $8539 in 2007.
  
  
  CONCLUSIONS
  IMRT and brachytherapy use increased substantially from 1998 to 2007; overall, radiation therapy costs increased by more than 50%. Radiation oncologists played an important role in treatment choice for both types of radiation therapy, whereas geographic region played a bigger role in the use of IMRT than brachytherapy.
authors.affiliation: Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center and Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Roberts
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Soulos
authors.forename: Jeph
authors.initials: J
authors.lastname: Herrin
authors.forename: James B
authors.initials: JB
authors.lastname: Yu
authors.forename: Jessica B
authors.initials: JB
authors.lastname: Long
authors.forename: Edward
authors.initials: E
authors.lastname: Dostaler
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D001943:Breast Neoplasms / Q000191:economics / Q000473:pathology / Q000532:radiotherapy*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics / Q000706:statistics & numerical data; D015412:Mastectomy, Segmental / Q000191:economics; D006278:Medicare / Q000191:economics*; D018714:Radiotherapy, Adjuvant / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D050397:Radiotherapy, Intensity-Modulated / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D018426:SEER Program; D012959:Socioeconomic Factors; D014481:United States