High costs drive underuse of brachytherapy for cervical cancer
High costs and greater usage of resources may explain the underuse of brachytherapy for locally advanced cervical cancer, according to findings published in International Journal of Radiation Oncology.
“Studies have time and time again shown that brachytherapy is the most important part of cervical cancer treatment, because it is essential to eradicating the tumor,” Timothy Showalter, MD, radiation oncologist at the University of Virginia Cancer Center, said in a press release. “A decline in brachytherapy utilization is associated with a higher rate of mortality in cervical cancer, so there’s a direct relationship.”
Showalter and colleagues evaluated the delivery costs and Medicare reimbursements for definitive radiation therapy in women with locally advanced cervical cancer. The researchers created process maps to represent each step of treatment, including equipment, personnel and consumable supplies. They also interviewed medical personnel to form an estimate of the time that would be consumed by treatment. Showalter and colleagues calculated the total cost of patient care, comparing the costs with 2016 Medicare reimbursement levels and relative value units.
Radiation therapy for cervical cancer cost a total of $12,861.68, with personnel costs constituting roughly half (49.8%) of the total. Brachytherapy represented 66.9% of the total cost, at $8,610.68. It also consumed 423 minutes of an attending radiation oncologist’s time — 80% of total.
The cost of brachytherapy was significantly higher than that of external beam radiation therapy, which cost $4,055.01 (31.5% of total).
Brachytherapy presented higher personnel costs than the sum of simulation and external beam radiation therapy ($4,798.73 vs. $1,404.72).
A full course of intensity-modulated radiation therapy represented 149.77 relative value units for radiation oncologists, whereas three-dimensional conformal radiation therapy offered 13.9 relative value units.
Total Medicare reimbursement was $23,321.71 for IMRT and $16,071.90 for three-dimensional conformal radiation therapy.
Brachytherapy showed a fourfold higher attending time per relative value unit (5.68 minutes) compared with either three-dimensional conformal radiation therapy (1.63 minutes) or IMRT (1.32 minutes).
“Brachytherapy requires a lot of physician effort and expertise and reimburses poorly for that effort,” Showalter said in the press release. “I can certainly imagine how the comparatively poor reimbursement rates compared [with] external beam radiation contribute, in some environments, to not establishing a service for brachytherapy or just not committing physician time to it.” – by Andy Polhamus
Disclosures: The authors report no relevant financial disclosures.