HER2 Support Group Forums - View Single Post - now bean counters looking at radiation therapy vs cyberknife

Lani · 10-09-2009, 10:19 AM

in this case for bone mets, but hopefully not for brain mets in the future

Efficacy, safety and quality of life need to be weighed in

2009 BC SYMPOSIUM: ABSTRACT #152: Cost comparisons for a course of radiation therapy for painful bone metastases from breast cancer using different technologies and fraction schema
[American Society of Clinical Oncology]
Background: Providers are faced with an array of options when sending their patients (pts) with painful bone metastases (PBM) for treatment (Rx) with radiation (RT). It has been shown (Hartsell et al. & others) that a single fraction(fx) of RT has equal efficacy to a 10 fx course with respect to pain relief & freedom from narcotic usage at 3 months. Nevertheless, some believe that delivery of a higher dose, as facilitated by fractionation and conformal Rx, may allow for greater long term palliation in select subgroups, such as pts with long life expectancies or radioresistant histologies. Different delivery systems & techniques—conventional RT (XRT), stereotactic radiosurgery (SRS), Cyberknife (CBK), & others- can be used, but are associated with different amounts of time involved by providers & pts alike, as well as different levels of reimbursement (reim).
Methods: CPT codes and Medicare reim were reviewed for seven potential scenarios for treatment of PBM. Freestanding (Fstd) estimate and Outpatient(OP) hospital estimate are based on WPS Medicare Michigan Locality 01 2009 and 2009 APC national reim rates. Using CPT codes that would be typically associated with a course of Rx, seven scenarios were reviewed: single fx and four fx courses with CBK in Fstd center and OP hospital settings, four fx course of SRS, and one and ten fx courses of XRT in an OP hospital setting.
Results: The results of the analysis is reported in the table.
Conclusions: There is a wide range of expense associated with the delivery of palliative RT for PBM, ranging from $1700 for a single fx of XRT delivered in an OP hospital setting, to $16118 for four fx of CBK in an OP hospital setting. This may have implications on the choice of modality for RT delivery for some providers and pts alike. Further research should examine the relative efficacy of the varied approaches commonly utilized for Rx of PBM to determine whether more expensive options are relatively cost-effective in any pt populations.

10-09-2009, 10:19 AM	#1
Lani Senior Member Join Date: Mar 2006 Posts: 4,778	now bean counters looking at radiation therapy vs cyberknife in this case for bone mets, but hopefully not for brain mets in the future Efficacy, safety and quality of life need to be weighed in 2009 BC SYMPOSIUM: ABSTRACT #152: Cost comparisons for a course of radiation therapy for painful bone metastases from breast cancer using different technologies and fraction schema [American Society of Clinical Oncology] Background: Providers are faced with an array of options when sending their patients (pts) with painful bone metastases (PBM) for treatment (Rx) with radiation (RT). It has been shown (Hartsell et al. & others) that a single fraction(fx) of RT has equal efficacy to a 10 fx course with respect to pain relief & freedom from narcotic usage at 3 months. Nevertheless, some believe that delivery of a higher dose, as facilitated by fractionation and conformal Rx, may allow for greater long term palliation in select subgroups, such as pts with long life expectancies or radioresistant histologies. Different delivery systems & techniques—conventional RT (XRT), stereotactic radiosurgery (SRS), Cyberknife (CBK), & others- can be used, but are associated with different amounts of time involved by providers & pts alike, as well as different levels of reimbursement (reim). Methods: CPT codes and Medicare reim were reviewed for seven potential scenarios for treatment of PBM. Freestanding (Fstd) estimate and Outpatient(OP) hospital estimate are based on WPS Medicare Michigan Locality 01 2009 and 2009 APC national reim rates. Using CPT codes that would be typically associated with a course of Rx, seven scenarios were reviewed: single fx and four fx courses with CBK in Fstd center and OP hospital settings, four fx course of SRS, and one and ten fx courses of XRT in an OP hospital setting. Results: The results of the analysis is reported in the table. Conclusions: There is a wide range of expense associated with the delivery of palliative RT for PBM, ranging from $1700 for a single fx of XRT delivered in an OP hospital setting, to $16118 for four fx of CBK in an OP hospital setting. This may have implications on the choice of modality for RT delivery for some providers and pts alike. Further research should examine the relative efficacy of the varied approaches commonly utilized for Rx of PBM to determine whether more expensive options are relatively cost-effective in any pt populations.