Pain relief with radiation Rx may come at too high a price

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.

“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,” said David D. Howell, MD, assistant professor of radiation oncology at the University of Michigan Medical School.

Compared with conventional treatments that are priced at $1,700 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.

The researchers 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: CyberKnife, another form of stereotactic radiosurgery, or conventional radiation. “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,” Dr. Howell said. “Cost is another parameter that should be considered” (Breast Cancer Symposium 2009 abstract 152).