Impact of Intensity-Modulated Radiotherapy on Health Care Costs of Patients With Anal Squamous Cell Carcinoma

Abstract

Purpose Drivers of variation in the cost of care after chemoradiotherapy for the management of anal squamous cell carcinoma (SCC) have not been fully elucidated. We sought to characterize the direct and indirect impact of radiotherapy modality on health care costs among patients with anal SCC. Patients and Methods A retrospective cohort study was performed using the 2014 linkage of the SEER-Medicare database. We identified 1,025 patients with anal SCC diagnosed between 2001 and 2011 and treated with chemoradiotherapy. Propensity score matching was used to balance baseline differences between patients treated with intensity-modulated radiotherapy (IMRT) and those treated with three-dimensional conformal radiotherapy (3D-CRT). Differences in total, cancer-attributable, and procedure-specific costs between groups were measured. Results Radiation-related, patient out-of-pocket, and total costs in the 1-year period after radiotherapy startwereallhigher fortheIMRTgroupthanthe3D-CRTgroup(mediantotal cost, $35,890 v $27,262, respectively; P < .001). Patients who received IMRT had lower cumulative costs associated with urgent hospitalizations and emergency department visits at both 9 months and 1 year after treatment start compared with a matched cohort of patients who received 3D-CRT (median, $711 v $4,957 at 1 year, respectively; P = .021). Conclusion Although total costs of care were higher for IMRT compared with 3D-CRT, primarily as a result of higher radiotherapy-specific costs, IMRT was associated with decreased unplanned health care utilization costs starting at 9 months after treatment start. Radiotherapy-centered episodes of care may need to encompass a longer time horizon to capture the full cost savings associated with more advanced radiation modalities.

Utilization of intensity modulated radiation therapy for anal cancer in the United States

“…In light of these data together with the aforementioned lack of further prospective work regarding this topic, it is important to appraise the cost-effectiveness of IMRT in this clinical circumstance. Two studies of cost have been performed using the SEER-Medicare database, demonstrating higher base costs for IMRT but decreased hospitalization-related costs (33,34). Presently, however, because neither of these "cost" studies were comparative "cost-effectiveness" studies, this question remains unresolved to date with respect to formal medico-economic analyses.…”

Patterns of care and outcomes of intensity modulated radiation therapy versus three-dimensional conformal radiation therapy for anal cancer

“…The management of undue side effects was evaluated in a 2014 linked SEER-Medicare database showing unplanned health care utilization costs such as emergency department visits and hospitalizations were higher among patients receiving 3DCRT over IMRT (median, $4,957 vs. $711; P=0.02) however, IMRT was associated with higher total costs than 3DCRT as expected (median total cost $35,890 vs. $27,262; P<0.001) (17). In the present study, income quartile and insurance status were not associated with increased utilization of IMRT, which may indicate high acceptance rates of insurance companies of IMRT.…”

The cost effectiveness of intensity-modulated radiation therapy and three-dimensional conformal radiotherapy in the treatment of head and neck cancers

“…In another study Lester-Coll et al concluded that the net cost of IMRT was $171,792 net cost of 3DCRT was $163,048 [ 20 ]. Chin et al showed that the median total cost for the IMRT group with $35,890 was higher than the 3D-CRT group with $27,262 [ 21 ].…”