Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Radiation Oncology, Jefferson University, Philadelphia, PA.
Clin Colorectal Cancer. 2019 Sep;18(3):209-217. doi: 10.1016/j.clcc.2019.05.005. Epub 2019 May 31.
Preoperative long-course chemoradiotherapy (CRT) and short-course radiotherapy (SCR) for locally advanced rectal cancer (LARC) were found to have equivalent outcomes in 3 randomized trials. SCR has not been widely adopted in the United States (US). Three-dimensional (3D) treatment planning is standard, whereas intensity-modulated radiotherapy (IMRT) is controversial. In this study, we assessed the economic impact of fractionation scheme and planning method for payers in the US.
We performed a population-based analysis of the total cost of radiotherapy for LARC in the US annually. The national annual target population was calculated using the Surveillance, Epidemiology, and End Results database. Radiotherapy costs were based on billing codes and 2018 pricing by Medicare's Hospital Outpatient Prospective Payment System.
We estimate that 12,945 patients with LARC are treated with radiotherapy annually in the US. The cost of CRT with 3D or IMRT is US $15,882 and $23,745 per patient, respectively. With SCR, the cost with 3D or IMRT is $5,458 and $7,323 per patient, respectively. The use of SCR would lead to 53% to 77% annual savings of $106,168,871 to $232,105,727 compared with CRT. IMRT increases the total cost of treatment by 34% to 50%, and if adopted widely, would lead to an excess cost of $24,152,134 and $101,784,723 annually with SCR and CRT, respectively.
SCR may have the potential to save approximately US $106 to t232 million annually in the US, likely without impacting outcomes. Lack of evidence showing benefit with costly IMRT should limit its use to clinical trials. It would be reasonable for public and private payers to consider which type of radiation is most suited to reimbursement.
三项随机试验发现，局部晚期直肠癌（LARC）的术前长程放化疗（CRT）和短程放疗（SCR）具有等效的结果。SCR 在美国尚未广泛采用。三维（3D）治疗计划是标准的，而调强放疗（IMRT）则存在争议。在这项研究中，我们评估了美国支付方在分割方案和计划方法方面的经济影响。
我们对美国每年 LARC 放疗的总费用进行了基于人群的分析。全国年度目标人群使用监测、流行病学和最终结果数据库计算。放疗费用基于计费代码和 2018 年医疗保险医院门诊预付款制度的定价。
我们估计，美国每年有 12945 例 LARC 患者接受放疗。3D 或 IMRT 的 CRT 成本分别为每位患者 15882 美元和 23745 美元。对于 SCR，3D 或 IMRT 的成本分别为每位患者 5458 美元和 7323 美元。与 CRT 相比，SCR 的使用将导致每年节省 106168871 美元至 232105727 美元，节省 53%至 77%。IMRT 使治疗总成本增加 34%至 50%，如果广泛采用，SCR 和 CRT 的年超额成本分别为 24152134 美元和 101784723 美元。
SCR 在美国每年可能有潜力节省约 1.06 亿至 2.32 亿美元，而不会影响结果。缺乏昂贵的 IMRT 具有获益的证据应限制其在临床试验中的使用。公共和私人支付方考虑哪种类型的辐射最适合报销是合理的。
