What Medicare would pay for and where a radiation oncologist practiced were two factors that strongly influenced the choice of intensity-modulated radiation therapy (IMRT) for treating breast cancer, according to an article published April 29 online in the Journal of the National Cancer Institute. The use of IMRT and the cost of radiation therapy increased sharply over the period of the study.
IMRT is a radiation delivery technique that modulates the radiation beams to conform to the shape of the tumor or tumor bed in an attempt to maximize the dose of radiation to the tumor while minimizing the dose to adjacent normal tissues. Compared to conventional, two- or three-dimensional radiation therapy, IMRT may reduce acute skin toxicity and improve cosmetic outcomes for women undergoing breast conservation therapy.
But there are simpler approaches to three-dimensional treatment that may provide the same benefits at lower cost. It is thus controversial whether such treatments justify billing Medicare for IMRT.
To look at clinical, demographic, and other factors associated with billing for IMRT in Medicare beneficiaries with breast cancer, Benjamin D. Smith, M.D., of the M. D. Anderson Cancer Center in Houston, Texas, and colleagues used Medicare data for 26,163 women with localized breast cancer who had undergone surgery and radiation therapy from 2001 through 2005.
They found that Medicare billing for IMRT increased more than 10-fold (increasing from 0.9% to 11.2% of the diagnosed patients) in that period. The average cost of radiation within the first year of diagnosis was $7,179 without IMRT and $15,230 with IMRT.
In regions of the country where local Medicare carriers covered IMRT, billing for this treatment was more than five times higher than in regions where it was not covered. Furthermore, IMRT billing was more frequent for patients treated by radiation oncologists in freestanding radiation centers (7.6%
|Contact: Kristine Crane|
Journal of the National Cancer Institute