(S016) Intermediate-Risk Prostate Cancer: A Medicare-Based Cost Comparison of Five Radiotherapy Regimens

April 30, 2015

Under current Medicare-allowable reimbursements, the cost of proton therapy relative to the cost of other therapeutic options is highly dependent on the number of radiotherapy fractions delivered. Ultimately, the cost of proton therapy will need to be weighed against tumor control probabilities, as well as the economic and quality of life benefits associated with reduced normal tissue exposure.

Romaine C. Nichols, MD, Kathy McIntyre, Juana Gifford, Steve Ritz, Stuart Klein, Curtis M. Bryan, MD, MPH, Randal H. Henderson, MD, MBA, William M. Mendenhall, MD, Nancy P. Mendenhall, MD, Bradford S. Hoppe, MD, MPH; Proton Therapy Institute, Department of Radiation Oncology, University of Florida

BACKGROUND: Patients with intermediate-risk prostate cancer choosing radiotherapy may be treated with a number of regimens. The current study compares the direct treatment cost for five therapeutic options based on fiscal year 2014 Medicare-allowable reimbursements.

METHODS: Hypothetical charge sheets were generated along with the expected Medicare-allowable reimbursements (based on global billing where applicable) for the following regimens: (1) image-guided intensity-modulated radiotherapy (IGIMRT) to a dose of 78 Gy in 39 fractions with one field reduction (IGIMRT); (2) dose-escalated IGIMRT to 84.60 Gy in 47 fractions with one field reduction (MSKCC-IGIMRT); (3) IGIMRT to a dose of 45 Gy in 25 fractions followed by a 90-seed I125 prostate implant (IGIMRT-BTX); (4) image-guided proton therapy to a dose of 78 Gy(relative biologic effectiveness [RBE]) in 39 fractions with one field reduction (SFPT); and (5) image-guided hypofractionated proton therapy to a dose of 72.50 Gy(RBE) in 29 fractions with one field reduction (HFPT).

RESULTS: Based on fiscal year 2014 Medicare-allowable reimbursements, the direct cost, including professional fees, technical fees, isotope costs, and facility fees, for each intervention is as follows: IGIMRT, $25,204.12; MSKCC-IGIMRT, $29,130.76; IGIMRT-BTX, $31,104.39; SFPT, $46,652.66; and HFPT, $34,977.54.

CONCLUSIONS: These data present a framework for evaluating the cost-effectiveness of proton therapy as compared to competing therapeutic options. Under current Medicare-allowable reimbursements, the cost of proton therapy relative to the cost of other therapeutic options is highly dependent on the number of radiotherapy fractions delivered. The feasibility of delivering hypofractionated proton therapy for patients with localized prostate cancer is being investigated at a number of institutions, as well as within the framework of a multicenter protocol. Ultimately, the cost of proton therapy will need to be weighed against tumor control probabilities, as well as the economic and quality of life benefits associated with reduced normal tissue exposure.

Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org