Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio.
Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia.
Pract Radiat Oncol. 2024 Jan-Feb;14(1):24-27. doi: 10.1016/j.prro.2023.09.003. Epub 2023 Sep 24.
For early stage breast cancer (BC), the choice of radiation therapy duration (1 vs 3 weeks) is highly debated. Cost and financial toxicity are major concerns that patients with BC face. Nonetheless, there remain limited discussions providing granular details of the role of insurance in the aggregate cost of 1 week versus 3 weeks of radiation therapy for patients. This project aims to disaggregate costs by plan to increase transparency of out-of-pocket (OOP) cost estimates in radiation therapy.
Treatment procedures were determined through the National Comprehensive Cancer Network guidelines. OOP treatment costs, deductibles, and copays/coinsurance were calculated by using Medicaid, Original Medicare, Medigap Plan G, and Medicare Part D prescription plans. The medicare.gov, medicaid.oh.gov, aarpmedicareplans.com, and the physician fee schedule from cms.gov were used to determine costs by treatment. Price estimates reflect actual costs per insurance plan rather than costs estimated from claims data. All procedures were considered to be performed in an Ohio hospital setting. One-week radiation therapy was defined as 5 fractions without boost, and 3-week radiation therapy was defined as 15 fractions without boost.
Medicare beneficiaries with Original Medicare coverage face an OOP treatment charge of $649.24 for 1 week of radiation therapy and $1006.20 for 3 weeks of radiation therapy. Assuming the deductible is met postlumpectomy, Medigap Plan G beneficiaries are faced with no additional charges for both lengths of radiation therapy. Similarly for Medicaid beneficiaries (assuming treatment is approved by Medicaid), all expenses are covered without limit, resulting in no OOP expense.
Considerations of 1 and 3 weeks of radiation therapy for postlumpectomy early-stage BC are often dependent on cancer characteristics and patient preferences. This model (based on actual cost estimates per insurance plan rather than claims data) compares OOP costs across Medicaid and Medicare plans, which more holistically informs providers and patients in radiation therapy duration decision making.
对于早期乳腺癌（BC），放射治疗持续时间（1 周与 3 周）的选择存在较大争议。成本和财务毒性是 BC 患者面临的主要问题。尽管如此，对于 1 周与 3 周放射治疗的总费用中保险所起的作用，仍缺乏提供详细信息的讨论。本项目旨在通过按计划细分成本，以提高放射治疗自付费用估计的透明度。
治疗方案通过国家综合癌症网络指南确定。通过 Medicaid、原始医疗保险、Medigap Plan G 和 Medicare Part D 处方药计划计算自付治疗费用、免赔额和共付额/自付额。使用 medicare.gov、medicaid.oh.gov、aarpmedicareplans.com 和 cms.gov 的医师费用表来确定按治疗方式计算的成本。价格估算反映了每个保险计划的实际费用，而不是根据理赔数据估算的费用。所有程序均被视为在俄亥俄州医院环境中进行。1 周放射治疗定义为 5 次无增量分割，3 周放射治疗定义为 15 次无增量分割。
接受原始医疗保险的 Medicare 受益人接受 1 周放射治疗的自付治疗费用为 649.24 美元，3 周放射治疗的自付治疗费用为 1006.20 美元。假设在乳房肿瘤切除术（lumpectomy）后达到免赔额，Medigap Plan G 受益人的两种放射治疗长度均无需支付额外费用。同样，对于 Medicaid 受益人（假设治疗获得 Medicaid 批准），所有费用均全额报销，无需支付任何自付费用。
对于乳房肿瘤切除术（lumpectomy）后的早期 BC，选择 1 周和 3 周的放射治疗往往取决于癌症特征和患者偏好。该模型（基于每个保险计划的实际费用估算，而不是理赔数据）比较了 Medicaid 和 Medicare 计划的自付费用，更全面地为放射治疗持续时间决策提供信息，让患者和提供者都受益。
