Variation in the Cost of Radiation Therapy Among Medicare Patients With Cancer.
OBJECTIVE
Radiation therapy represents a major source of health care expenditure for patients with cancer. Understanding the sources of variability in the cost of radiation therapy is critical to evaluating the efficiency of the current reimbursement system and could shape future policy reform. This study defines the magnitude and sources of variation in the cost of radiation therapy for a large cohort of Medicare beneficiaries.


METHODS
We identified 55,288 patients within the SEER database diagnosed with breast, lung, or prostate cancer between 2004 and 2009. The cost of radiation therapy was estimated from Medicare reimbursements. Multivariable linear regression models were used to assess the influence of patient, tumor, and radiation therapy provider characteristics on variation in cost of radiation therapy.


RESULTS
For breast, lung, and prostate cancers, the median cost (interquartile range) of a course of radiation therapy was $8,600 ($7,300 to $10,300), $9,000 ($7,500 to $11,100), and $18,000 ($11,300 to $25,500), respectively. For all three cancer subtypes, patient- or tumor-related factors accounted for < 3% of the variation in cost. Factors unrelated to the patient, 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.


CONCLUSIONS
In this study, factors unrelated to the individual patient accounted for the majority of variation in the cost of radiation therapy, suggesting potential inefficiency in health care expenditure. Future research should determine whether this variability translates into improved patient outcomes for further evaluation of current reimbursement practices.
Moores Cancer Center, University of California San Diego, La Jolla, CA; and Medical Informatics Center, Peking University, Beijing, People's Republic of China.
Anthony J
AJ
Paravati
Moores Cancer Center, University of California San Diego, La Jolla, CA; and Medical Informatics Center, Peking University, Beijing, People's Republic of China.
Isabel J
IJ
Boero
Moores Cancer Center, University of California San Diego, La Jolla, CA; and Medical Informatics Center, Peking University, Beijing, People's Republic of China.
Daniel P
DP
Triplett
Moores Cancer Center, University of California San Diego, La Jolla, CA; and Medical Informatics Center, Peking University, Beijing, People's Republic of China.
Lindsay
L
Hwang
Moores Cancer Center, University of California San Diego, La Jolla, CA; and Medical Informatics Center, Peking University, Beijing, People's Republic of China.
Rayna K
RK
Matsuno
Moores Cancer Center, University of California San Diego, La Jolla, CA; and Medical Informatics Center, Peking University, Beijing, People's Republic of China.
Beibei
B
Xu
Moores Cancer Center, University of California San Diego, La Jolla, CA; and Medical Informatics Center, Peking University, Beijing, People's Republic of China.
Loren K
LK
Mell
Moores Cancer Center, University of California San Diego, La Jolla, CA; and Medical Informatics Center, Peking University, Beijing, People's Republic of China j2murphy@ucsd.edu.
James D
JD
Murphy
D005260:Female; D005102:Health Expenditures / Q000639:trends*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics*; D009369:Neoplasms / Q000191:economics*; D011881:Radiotherapy, Computer-Assisted / Q000191:economics*; D018426:SEER Program; D014481:United States