PMID- 38072324
OWN - NLM
STAT- MEDLINE
DCOM- 20240419
LR  - 20240419
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
VI  - 119
IP  - 1
DP  - 2024 May 1
TI  - Trends in Utilization and Medicare Spending on Short-Course Radiation Therapy for 
      Breast and Prostate Cancer: An Episode-Based Analysis From 2015 to 2019.
PG  - 17-22
LID - S0360-3016(23)08173-7 [pii]
LID - 10.1016/j.ijrobp.2023.11.043 [doi]
AB  - PURPOSE: Evidence supports the value of shorter, similarly efficacious, and 
      potentially more cost-effective hypofractionated radiation therapy (RT) regimens 
      in many clinical scenarios for breast cancer (BC) and prostate cancer (PC). 
      However, practice patterns vary considerably. We used the most recent Centers for 
      Medicare and Medicaid Services data to assess trends in RT cost and practice 
      patterns among episodes of BC and PC. METHODS AND MATERIALS: We performed a 
      retrospective cohort analysis of all external beam RT episodes for BC and PC from 
      2015 to 2019 to assess predictors of short-course RT (SCRT) use and calculated 
      spending differences. Multivariable logistic regression defined adjusted odds 
      ratios of receipt of SCRT over longer-course RT (LCRT) by treatment modality, 
      age, year of diagnosis, type of practice, and the interaction between year and 
      treatment setting. Medicare spending was evaluated using multivariable linear 
      regression controlling for duration of RT regimen (SCRT vs LCRT) in addition to 
      the above covariables. RESULTS: Of 143,729 BC episodes and 114,214 PC episodes, 
      63,623 (44.27%) and 25,955 (22.72%) were SCRT regimens, respectively. Median 
      total spending for SCRT regimens among BC episodes was $9418 (interquartile range 
      [IQR], $7966-$10,983) versus $13,602 (IQR, $11,814-$15,499) for LCRT. Among PC 
      episodes, median total spending was $6924 (IQR, $4,509-$12,905) for stereotactic 
      body RT, $18,768 (IQR, $15,421-$20,740) for moderate hypofractionation, and 
      $27,319 (IQR, $25,446-$29,421) for LCRT. On logistic regression, receipt of SCRT 
      was associated with older age among both BC and PC episodes as well as treatment 
      at hospital-affiliated over freestanding sites (P < .001 for all). CONCLUSIONS: 
      In this evaluation of BC and PC RT episodes from 2015 to 2019, we found that 
      shorter-course RT resulted in lower costs than longer-course RT. SCRT was also 
      more common in hospital-affiliated sites. Future research focusing on potential 
      payment incentives encouraging SCRT when clinically appropriate in the 2 most 
      common cancers treated with RT will be valuable as the field continues to 
      prospectively evaluate cost-effective hypofractionation in other disease sites.
CI  - Copyright (c) 2023 Elsevier Inc. All rights reserved.
FAU - Patel, Tej A
AU  - Patel TA
AD  - Department of Healthcare Management and Policy, University of Pennsylvania, 
      Philadelphia, Pennsylvania.
FAU - Jain, Bhav
AU  - Jain B
AD  - Department of Health Policy, Stanford University School of Medicine, Stanford, 
      California.
FAU - Vapiwala, Neha
AU  - Vapiwala N
AD  - Department of Radiation Oncology, University of Pennsylvania, Philadelphia, 
      Pennsylvania.
FAU - Chino, Fumiko
AU  - Chino F
AD  - Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New 
      York, New York.
FAU - Tringale, Kathryn R
AU  - Tringale KR
AD  - Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New 
      York, New York; Department of Radiation Medicine and Applied Sciences, University 
      of California, San Diego, School of Medicine, San Diego, California.
FAU - Mahal, Brandon A
AU  - Mahal BA
AD  - Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, 
      University of Miami Miller School of Medicine, Miami, Florida.
FAU - Yamoah, Kosj
AU  - Yamoah K
AD  - Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research 
      Institute, Tampa, Florida.
FAU - McBride, Sean N
AU  - McBride SN
AD  - Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New 
      York, New York.
FAU - Lam, Miranda B
AU  - Lam MB
AD  - Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and 
      Women's Hospital, Harvard Medical School, Boston, Massachusetts.
FAU - Hubbard, Anne
AU  - Hubbard A
AD  - Department of Health Policy, American Society for Radiation Oncology, Arlington, 
      Virgnia.
FAU - Nguyen, Paul L
AU  - Nguyen PL
AD  - Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and 
      Women's Hospital, Harvard Medical School, Boston, Massachusetts.
FAU - Dee, Edward Christopher
AU  - Dee EC
AD  - Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New 
      York, New York. Electronic address: deee1@mskcc.org.
LA  - eng
PT  - Journal Article
DEP - 20231208
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
SB  - IM
MH  - Male
MH  - Humans
MH  - Aged
MH  - United States
MH  - Medicare
MH  - Retrospective Studies
MH  - *Prostatic Neoplasms
MH  - Neoadjuvant Therapy/methods
MH  - *Breast Neoplasms
EDAT- 2023/12/11 00:42
MHDA- 2024/04/19 06:43
CRDT- 2023/12/10 19:32
PHST- 2023/06/19 00:00 [received]
PHST- 2023/11/16 00:00 [revised]
PHST- 2023/11/22 00:00 [accepted]
PHST- 2024/04/19 06:43 [medline]
PHST- 2023/12/11 00:42 [pubmed]
PHST- 2023/12/10 19:32 [entrez]
AID - S0360-3016(23)08173-7 [pii]
AID - 10.1016/j.ijrobp.2023.11.043 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2024 May 1;119(1):17-22. doi: 
      10.1016/j.ijrobp.2023.11.043. Epub 2023 Dec 8.