A new study finds that intensity-modulated radiation therapy (IMRT) use for breast cancer is five times higher in regions where Medicare covers the technique than in regions where Medicare does not cover the technique. The study, published online April 29 in the Journal of the National Cancer Institute, also found that IMRT use was 36 percent higher for women treated at private radiation clinics than in hospital-based outpatient clinics and that regional differences in reimbursement policies appear to strongly influence the use of IMRT.
Because other 3-dimensional radiation planning methods that are less expensive than IMRT but likely as effective are available, the study authors suggest that Medicare reimbursement options for breast radiation therapy be expanded to allow the use of these less-expensive radiation planning methods.
Between 2001 and 2005, the number of Medicare claims for IMRT for breast cancer rose from 0.9 percent to 11.2 percent of overall radiation therapy claims. The increased use of IMRT contributed to a 26 percent increase in the cost of radiation therapy for breast cancer during the time period studied, reported researchers led by Dr. Benjamin D. Smith of the University of Texas M. D. Anderson Cancer Center.
Dr. Smith and his colleagues used the linked SEER-Medicare database to collect data on 26,163 women 66 years of age and older treated with surgery and adjuvant radiation therapy for nonmetastatic breast cancer.
The mean cost of radiation therapy given in the first year after diagnosis was $7,170 for women who did not receive IMRT and $15,230 for women who received IMRT. Costs related to radiation therapy accounted for 33 percent of total medical care costs for women who did not receive IMRT and 52 percent of costs for those who received IMRT.
Because the characteristics of patients’ tumors were not strongly associated with whether IMRT was used, whereas allowed reimbursement was associated with IMRT use, the study results “would appear to confirm the suspicion…that medical decision making is too heavily influenced by reimbursement rather than medical necessity,” wrote Drs. Lisa A. Kachnic and Simon N. Powell of the Boston University Medical Center in an accompanying editorial.
Whether IMRT for breast cancer is more effective at targeting cancer cells or reducing side effects than less-expensive 3-dimensional radiation techniques is still unclear. Clinical trials are needed to understand which women with breast cancer benefit the most from IMRT, they added
NCI Cancer Bulletin for May 3, 2011 - National Cancer Institute
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