Pain relief may come at too high a price

October 19, 2009

An analysis by researchers at the University of Michigan Comprehensive Cancer Center shows that costs vary widely for different treatment regimens and from one delivery method to another. Yet receiving more treatments and spending extra on more sophisticated technology may do little good, at least when it comes to pain relief.

An analysis by researchers at the University of Michigan Comprehensive Cancer Center shows that costs vary widely for different treatment regimens and from one delivery method to another. Yet receiving more treatments and spending extra on more sophisticated technology may do little good, at least when it comes to pain relief.
 

When cancer spreads to the bone, radiation treatments can help relieve pain caused by the tumor. A single treatment with conventional radiation techniques can cost around $1700. Patients may receive multiple treatments. Yet research has shown a single treatment with standard radiation can be as effective as 10 treatments. Fewer treatments also spare patients and their caregivers from more trips to the radiation department and reduce a patient's radiation burden. The same disconnect between more money spent and better results is seen when using conventional versus advanced equipment to deliver this radiation.

"Some of the technologies that have been shown to be safe and effective, but have not been shown to be superior, can cost up to 10 times what a single dose of conventionally delivered radiation costs," says Dr. David D. Howell, assistant professor of radiation oncology at the University of Michigan Medical School.

Compared with conventional treatments that are priced at $1700 per treatment, costs can rise to more than $16,000 for four treatments using stereotactic radiosurgical devices such as the Cyberknife. If such devices have not been proven to be better, why, then, do some doctors use the more expensive methods? Possibly because they believe more recently developed technologies yield better pain control or fewer side effects in the long term for certain patients, Dr. Howell said.

In doing their research, the UM team used regional Medicare reimbursement codes to look at reimbursements associated with seven different radiation treatment scenarios for cancer that has spread to the bone. This included the number of treatments given, the setting-either freestanding or hospital-based center-of care, and the use of one of three different radiation technologies: the Cyberknife, another form of stereotactic radiosurgery, or conventional radiation.

Most radiation oncologists will consider a variety of factors in choosing a treatment strategy, such as the location and type of cancer, how well it may respond to radiation, and the patient's previous and current cancer treatment.

"In considering the big picture of patient care and treatments for cancer, safety, efficacy, side effects, the patient's time commitment and comfort all should enter into the mix," Howell said. "Cost is another parameter that should be considered."