Harvard Radiation Oncology Program, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts.
Int J Radiat Oncol Biol Phys. 2023 Jan 1;115(1):23-33. doi: 10.1016/j.ijrobp.2022.04.053. Epub 2022 Oct 26.
Using hospital-reported price data, we analyzed whether various market factors including radiation oncology practice consolidation were associated with higher commercial prices for radiation therapy (RT).
We evaluated commercial prices paid by private insurers for 4 common RT procedures-intensity modulated RT (IMRT) planning, IMRT delivery, 3-dimensional RT (3D-RT) planning, and 3D-RT delivery-reported among the 2096 hospitals in the United States that deliver RT according to the Medicare Provider of Service file. To assess price variation within hospitals, we evaluated the ratio of the 90th percentile price to the 10th percentile price among different private insurers. To assess regional variation, we similarly compared median commercial prices at the 90th and 10th percentile hospitals in each Hospital Referral Region. We generated multivariable models to test the association of various hospital, health system, regional, and market factors on median hospital commercial prices.
A total of 1004 hospitals (47.9%) reported at least 1 commercial price for any of the 4 RT procedures considered in this study. National median commercial prices for IMRT planning and IMRT delivery were $4073 (interquartile ratio [IQR], $2242-$6305) and $1666 (IQR, $1014-$2619), respectively. Prices for 3D-RT planning and 3D-RT delivery were $2824 (IQR, $1339-$4738) and $616 (IQR, $419-877), respectively. Within hospitals, the 90th percentile price paid by a private insurer was 2.3 to 2.5 times higher on average than the 10th percentile price, depending on the procedure. Within each Hospital Referral Region, the median price at the 90th percentile hospital was between 2.4 and 3.2 times higher than at the 10th percentile hospital. On multivariable analysis, higher prices were generally observed at hospitals with for-profit ownership, teaching status, and affiliation with large health systems. Levels of radiation oncology practice consolidation were not significantly associated with any prices.
Commercial prices for common RT procedures vary by more than a factor of 2 depending on a patient's private insurer and hospital of choice. Higher prices were more likely to be found at for-profit hospitals, teaching hospitals, and hospitals affiliated with large health systems.
利用医院报告的价格数据，我们分析了各种市场因素（包括放射肿瘤学实践整合）是否与放射治疗（RT）的商业价格较高有关。
我们评估了美国根据 Medicare Provider of Service 文件提供 RT 的 2096 家医院中，私人保险公司为 4 种常见 RT 程序（调强放射治疗[IMRT]计划、IMRT 交付、三维放射治疗[3D-RT]计划和 3D-RT 交付）支付的商业价格。为了评估医院内的价格差异，我们评估了不同私人保险公司之间第 90 百分位价格与第 10 百分位价格的比率。为了评估区域差异，我们同样比较了每个医院转诊区中第 90 百分位和第 10 百分位医院的中位数商业价格。我们生成多变量模型，以测试各种医院、医疗系统、区域和市场因素对医院商业价格中位数的关联。
共有 1004 家医院（47.9%）报告了本研究中考虑的 4 种 RT 程序中的至少一种商业价格。IMRT 规划和 IMRT 交付的全国中位数商业价格分别为 4073 美元（四分位距[IQR]，2242-6305 美元）和 1666 美元（IQR，1014-2619 美元）。3D-RT 规划和 3D-RT 交付的价格分别为 2824 美元（IQR，1339-4738 美元）和 616 美元（IQR，419-877 美元）。在医院内部，私人保险公司支付的第 90 百分位价格平均比第 10 百分位价格高 2.3 至 2.5 倍，具体取决于程序。在每个医院转诊区，第 90 百分位医院的中位数价格比第 10 百分位医院高 2.4 至 3.2 倍。在多变量分析中，通常在营利性所有权、教学地位和与大型医疗系统有关联的医院中观察到较高的价格。放射肿瘤学实践整合水平与任何价格均无显著关联。
根据患者的私人保险公司和选择的医院，常见 RT 程序的商业价格差异超过 2 倍。在营利性医院、教学医院和大型医疗系统附属的医院中，价格更有可能较高。
