Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
Int J Radiat Oncol Biol Phys. 2017 Nov 1;99(3):524-529. doi: 10.1016/j.ijrobp.2017.06.2447. Epub 2017 Jun 27.
European data suggest that 8-fraction stereotactic body radiation therapy (SBRT) regimens may be similar in efficacy with less toxicity than ≤5-fraction SBRT for central lung lesions. However, under current Centers for Medicare and Medicaid Services guidelines, SBRT in the United States (US) is reimbursed for only ≤5 fractions, whereas there are no such restrictions for reimbursement in Canada. We hypothesize that US-specific SBRT reimbursement policies influence the use of ≥5-fraction SBRT in US academic centers in comparison with comparable Canadian centers.
A 15-question electronic survey was distributed to radiation oncologists at National Cancer Institute-designated cancer centers in the US and the 10 highest research-funded cancer centers in Canada. Fisher exact test or exact logistic regression if applicable was used, where P<.05 was considered statistically different from neutral.
Of the 143 radiation oncologists from 60 US cancer centers and 6 Canadian cancer centers who completed the survey (17.6% response rate), 125 routinely prescribe SBRT. Fifty percent of US physicians versus 0% of Canadian physicians indicated that there are instances when they would like to prescribe >5-fraction SBRT but prescribe ≤5 fractions because of insurance reimbursement (P=.076 and P=.001, respectively). Seventy percent (P=.006) of US radiation oncologists versus 0% (P=.001) of Canadian radiation oncologists report that SBRT clinical investigation is constrained by the insurance reimbursement. The most common reported deterrent to prescribing >5-fraction SBRT in the US was insurance reimbursement (49.5%).
US radiation oncologists are more likely than those in Canada to report that SBRT clinical investigation and >5-fraction SBRT use may be negatively influenced by health insurance reimbursement; this perception was not held by physicians in Canada. Health care environment may significantly affect radiation therapy decision making and practice patterns.
欧洲数据表明，8 个分割的立体定向体放射治疗（SBRT）方案在疗效上可能与≤5 个分割的 SBRT 相似，而毒性更小，适用于中央肺部病变。然而，根据当前美国医疗保险和医疗补助服务中心的指导方针，SBRT 在美国仅可报销≤5 个分割，而在加拿大则没有此类报销限制。我们假设，美国特有的 SBRT 报销政策会影响美国学术中心使用≥5 个分割的 SBRT，与加拿大可比中心相比。
向美国国立癌症研究所指定癌症中心和加拿大 10 个研究经费最高的癌症中心的放射肿瘤学家分发了一份包含 15 个问题的电子调查。如果适用，使用 Fisher 精确检验或精确逻辑回归，P<.05 被认为与中立有统计学差异。
在完成调查的 60 个美国癌症中心和 6 个加拿大癌症中心的 143 名放射肿瘤学家中，有 125 名常规开具 SBRT 处方。50%的美国医生表示，在某些情况下，他们希望开具>5 个分割的 SBRT，但由于保险报销而开具≤5 个分割（P=.076 和 P=.001）。70%（P=.006）的美国放射肿瘤学家表示，SBRT 临床研究受到保险报销的限制，而 0%（P=.001）的加拿大放射肿瘤学家则表示。在美国，最常见的报告限制开具>5 个分割 SBRT 的原因是保险报销（49.5%）。
与加拿大的医生相比，美国的放射肿瘤学家更有可能报告说，SBRT 临床研究和>5 个分割的 SBRT 使用可能受到健康保险报销的负面影响；加拿大的医生没有这种看法。医疗保健环境可能会对放射治疗决策和实践模式产生重大影响。
