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

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OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

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

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
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