Cost of Intensity-modulated Radiation Therapy for Older Patients with Stage III Lung Cancer

Kale, Minal; Mhango, Grace; Bonomi, Marcelo; Federman, Alex D.; Sigel, Keith; Rosenzweig, Kenneth E.; Wisnivesky, Juan P.

doi:10.1513/annalsats.201603-156oc

Cited by 8 publications

(5 citation statements)

References 35 publications

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“…It is possible that using the CPI for inflation adjustment may have overinflated earlier years of data, biasing our analysis toward the null . However, we felt justified using the CPI given that the CPI has precedent in similar radiotherapy-related spending analyses in the literature . Furthermore, spending results were consistent even when using an alternative inflation index that is not thought to overinflate earlier years of cost data.…”

Section: Discussionmentioning

confidence: 86%

Association of Utilization Management Policy With Uptake of Hypofractionated Radiotherapy Among Patients With Early-Stage Breast Cancer

et al. 2020

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IMPORTANCE Breast cancer accounts for the largest portion of cancer-related spending in the United States. Although hypofractionated radiotherapy after breast-conserving surgery is a cost-effective and convenient treatment strategy for patients with early-stage breast cancer, less than 40% of eligible women received hypofractionated radiotherapy in 2013.OBJECTIVE To assess the association of a large commercial payer's utilization management policy with the use of hypofractionated radiotherapy among women with early-stage breast cancer and its associated cost. DESIGN, SETTING, AND PARTICIPANTSA retrospective, adjusted difference-in-differences economic analysis was conducted using administrative claims data from January 1, 2012, to June 1, 2018, of women 18 years or older with early-stage breast cancer who were eligible for hypofractionated radiotherapy according to 2011 guidelines from the American Society for Radiation Oncology and were continuously enrolled in 14 geographically diverse commercial health plans covering 6.9% of US adult women. Women who received mastectomy, brachytherapy, or less than 11 or more than 40 external beam fractions of radiotherapy were excluded. A utilization management policy was used to encourage the use of hypofractionated radiotherapy among women in fully insured and Medicare Advantage (fully insured) plans. Under the new policy, claims for extended-course radiotherapy were not reimbursed for fully insured women who were eligible for hypofractionated radiotherapy. This policy did not apply to women in self-insured or Medicare supplemental insurance (self-insured) plans, allowing these groups to serve as a comparison group. MAIN OUTCOMES AND MEASURESThe primary outcome was use of hypofractionated radiotherapy, and the secondary outcome was the cost of this type of radiotherapy. RESULTSOf 10 540 eligible women, 3619 (34.3%) were in fully insured plans and thus subject to the policy. There were no meaningful differences between the fully insured and self-insured groups in mean (SD) age at the start of radiotherapy (63.8 [8.6] vs 65.0 [8.9] years), mean (SD) Charlson Comorbidity Index score (3.0 [1.5] vs 3.2 [1.6]), or practice setting (outpatient hospital setting, 2982 of 3619 [82.4%] vs 5600 of 6921 [80.9%]). The policy was associated with an increase in use of hypofractionated radiotherapy among fully insured patients subject to the policy (adjusted percentage point difference-in-difference, 4.2%; 95% CI, 0.0%-8.4%; P = .05) and a nonsignificant decrease in radiotherapy-associated expenditures (−$2275 relative to self-insured patients; P = .09). Spillover analyses revealed a significantly higher uptake of hypofractionated radiotherapy among self-insured patients who were indirectly exposed to the policy (adjusted percentage point difference-indifference, 8.5%; 95% CI, 3.6%-13.5%; P < .001) compared with those who were not exposed. CONCLUSIONS AND RELEVANCEThis study suggests that a payer's utilization management policy was associated with direct and spillover increases in the use ...

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Section: Discussionmentioning

confidence: 86%

Association of Utilization Management Policy With Uptake of Hypofractionated Radiotherapy Among Patients With Early-Stage Breast Cancer

et al. 2020

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“…Although single-center retrospective studies found promising results with IMRT despite its use for more advanced disease, population-based retrospective studies showed mixed results. Studies using the SEER database did not show a clear benefit in OS or reduction in pulmonary or esophageal toxicity for IMRT compared to 3DCRT (51)(52)(53)(54). Importantly, toxicity data was based on Medicare claims, which does not provide information on toxicity grade.…”

Section: Retrospective Clinical Studiesmentioning

confidence: 99%

“…Although IMRT is used routinely for locally advanced NSCLC, widespread use is limited because of a lack of highquality evidence establishing superiority and the requirement for more advanced delivery systems and dose calculation algorithms. Using data from the SEER registry linked to Medicare claims, Kale et al estimated that RT-related costs were $6,850 higher per patient for IMRT versus 3DCRT (54).…”

Section: Implementation Challengesmentioning

confidence: 99%

Advanced radiation techniques for locally advanced non-small cell lung cancer: intensity-modulated radiation therapy and proton therapy

Yegya-Raman¹,

Zou²,

Nie³

et al. 2018

J. Thorac. Dis.

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Radiation therapy (RT) represents an integral part of a multimodality treatment plan in the definitive, preoperative and postoperative management of non-small cell lung cancer (NSCLC). Technological advances in RT have enabled a shift from two-dimensional radiotherapy to more conformal techniques. Three-dimensional conformal radiotherapy (3DCRT), the current minimum technological standard for treating NSCLC, allows for more accurate delineation of tumor burden by using computed tomography-based treatment planning instead of two-dimensional radiographs. Intensity-modulated RT (IMRT) and proton therapy represent advancements over 3DCRT that aim to improve the conformity of RT and provide the possibility for dose escalation to the tumor by minimizing radiation dose to organs at risk. Both techniques likely confer benefits to certain anatomic subgroups of NSCLC requiring RT. This article reviews pertinent studies evaluating the use of IMRT and proton therapy in locally advanced NSCLC, and outlines challenges, indications for use, and areas for future research.

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“…6 This is probably because of higher costs incurred per patient when using IMRT for lung cancer, as shown in another report from the Surveillance, Epidemiology, and End Results registry-Medicare. 26 IMRT also requires highly trained staff using more advance planning systems, complex dose calculation algorithms and more advanced radiotherapy delivery systems with robust image-guidance. 4 However, in our high-volume centre with good IMRT planning experience, IMRT was used when necessary for adequately and safely treating the PTV, whilst satisfying the dose constraints for organs at risk.…”

Section: Shrimali Et Almentioning

confidence: 99%

Impact of modern radiotherapy techniques on survival outcomes for unselected patients with large volume non-small cell lung cancer

Shrimali

Chakraborty

Prasath

et al. 2018

The British Journal of Radiology

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A significant proportion of patients with non-metastatic non-small cell lung cancers (NSCLC) present with locally advanced (stages IIIA and IIIB) disease. 1,2 Radical radiotherapy combined with chemotherapy given concurrently or sequentially remains the standard treatment for most patients with inoperable, locally advanced NSCLC. 3,4 Planning radical radiotherapy for Stage III and large volume lung cancers can be challenging. With wider availability of inverse planning, intensity modulated radiotherapy (IMRT) is being increasingly used for the treatment of these patients with NSCLC, despite the absence of randomised comparison with three-dimensional conformal radiotherapy (3DCRT) in controlled trials. 5-7 When discussing treatment options, the information for patients is often based on the expected outcome from published trials. It remains to be seen whether the outcomes reported in large randomised controlled trials (RCTs) with strict entry criteria, hold true for unselected, real-world patients with larger radiation target volumes that are routinely treated outside the controlled environment of these clinical trials. 8-10 The median planning target volume (PTV) reported in a large contemporary trial, the Radiation Therapy Oncology Group-0617 trial (RTOG 0617), was 426 and 486 cc for patients treated using 3DCRT and IMRT, respectively. 10

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Cost of Intensity-modulated Radiation Therapy for Older Patients with Stage III Lung Cancer

Cited by 8 publications

References 35 publications

Association of Utilization Management Policy With Uptake of Hypofractionated Radiotherapy Among Patients With Early-Stage Breast Cancer

Association of Utilization Management Policy With Uptake of Hypofractionated Radiotherapy Among Patients With Early-Stage Breast Cancer

Advanced radiation techniques for locally advanced non-small cell lung cancer: intensity-modulated radiation therapy and proton therapy

Impact of modern radiotherapy techniques on survival outcomes for unselected patients with large volume non-small cell lung cancer

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