A study comparing the cost of hypofractionated radiotherapy for early-stage breast cancer with the more expensive multidose conventional form, finds that physicians are increasingly opting for hypofractionated radiotherapy despite lower reimbursements rates for the procedure.
Hypofractionated radiotherapy is administered in fewer fractions requiring fewer hospital visits, which, in turn, should lead to less expensive procedures. According to previously reported randomized controlled trials of patients with early breast cancer, both procedures are equally efficacious. In 2011, the American Society of Radiation Oncology published guidelines recommending hypofractionated whole-breast irradiation for patients who have not undergone chemotherapy and who are at least 50 years old with a small primary tumor (T1-2).
In the new study, Loren Saulsberry, PhD, of the department of public health at the University of Chicago, and colleagues Chuanhong Liao and Dezheng Huo, hypothesized that a fee-for-service incentive structure in which doctors are paid by volume and quantity of services, would drive up use of conventional therapy among patients with commercial insurance. And, they hypothesized that, when presented with a smaller cost difference between the two procedures, physicians would recommend hypofractionated radiotherapy over the conventional form, but neither theory was proven true.
This was a retrospective study of private employer–sponsored health insurance claims processed between 2008 and 2017 for women with early-stage breast cancer who were treated with lumpectomy and whole-breast irradiation.
The study included 15,869 women who received hypofractionated radiotherapy and 59,328 who received the conventional form. Women who underwent hypofractionated radiotherapy received 15-24 fractions over 21-31 days. Those who received conventional radiotherapy received 25-40 fractions over 39-120 days. The primary outcomes and measures were the use of hypofractionated or conventional radiotherapy, costs incurred by insurers and out-of-pocket patient expenses.
Dr. Saulsberry and colleagues found the use of hypofractionated radiotherapy increased during this period. They found no association between the likelihood of receiving hypofractionated radiotherapy and insurance plan characteristics. At $23,286, conventional radiotherapy was $6,253 more expensive than hypofractionated radiotherapy which averaged $17,763.
After out-of-pocket expenses were paid (average of $502 for conventional and $363 for hypofractionated radiotherapy), insurers paid an average of $6,375 more for conventional therapy after adjustments.
“Hypofractionated radiotherapy represents significant savings to both the health care system and to individual patients. It may soon become the dominant form of radiation treatment in the U.S. if current trends continue,” Dr. Saulsberry said in an interview after she presented the study (Abstract P3-19-07) at the San Antonio Breast Cancer Symposium.
According to the National Cancer Institute, the cost of cancer care grew from $190.2 billion in 2015 to $208.9 billion in 2020.
Dr. Saulsberry declared no conflicts of interest.