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Is Radiation Overuse Contributing to Higher Healthcare Costs?

A study uncovered that most breast cancer patients received longer and more expensive radiation treatments than medically necessary, resulting in $164 million more in healthcare costs.

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- Oncologists could have saved over $164 million in healthcare costs if they had adhered to clinical guidelines and prescribed shorter radiation treatment for some breast cancer patients, a recent Journal of Oncology Practice study revealed.

Only 26 percent of T1 and T2 invasive breast cancer patients with clinically node-negative who were treated with lumpectomy during 2011 received the least costly radiation regimen for which they were safely eligible, reported researchers from the Duke University Medical Center, Duke Cancer Institute, and Massachusetts General Hospital Cancer Center.

“It’s important to look for opportunities in cancer treatment where we can safely reduce healthcare costs without compromising excellent outcomes,” Rachel A. Greenup, MD, lead author of the study and an assistant professor of surgery at Duke, stated in a press release.

“Our study provides an example of a win-win situation, where patients can receive high-quality, evidence-based cancer care while also reducing the treatment burden for patients and the healthcare system.”

Based on American College of Surgeons National Cancer Database information, researchers concluded that many oncologists demonstrated inappropriate resource use for breast cancer treatments, resulting in higher healthcare costs.

Breast cancer continues to be one of the most expensive cancers to treat, with estimated healthcare costs to reach $20 billion by 2020, according to a 2011 Journal of the National Cancer Institute study.

Radiation treatment costs significantly contribute to higher healthcare costs for breast cancer. Research from 2012 revealed that radiation treatment can cost between $5,300 and $13,300 per patient and healthcare costs increased depending on the number of delivered fractions and regimen length.

To curb breast cancer treatment costs, industry experts suggested limiting radiation treatment for some patients. As part of the Choosing Wisely campaign, the American Society of Radiation Oncology developed a clinical guideline that suggested oncologists consider shorter treatment regimens for women 50 years old or younger with early-stage invasive cancer.

However, the Duke and Massachusetts General Hospital researchers found that only 28 percent of patients studied received the least expensive and evidence-based radiation treatment regimen for which they were potentially eligible.

In contrast, 57 percent of breast cancer patients underwent the most expensive radiation treatment plan and 15 percent received less radiation treatment than they were safely eligible for per the clinical guidelines.

As a result, the estimated total healthcare costs for radiation treatment among the over 40,000-patient cohort was $420.2 million in 2011.

Researchers reported that the shorter course of radiation treatment was projected to cost significantly less than the longer regimen. A four-week course of radiation therapy would have cost just $8,000 versus $13,000 for the traditional six-week treatment.

If the cohort had undergone the least expensive radiation treatment for which they were safely eligible, the healthcare costs for the same group would have been $256.6 million, representing a 39 percent reduction in healthcare spending for 2011.

Study findings indicate that oncologists are not following clinical guidelines as well as they could be, resulting in more low-value resource use.

Another recent study from Deloitte also pointed to specialty accountable care organizations (ACOs) as a mechanism for reducing radiation therapy utilization. The consulting firm found that the ACO’s financial incentive structure motivated providers to reduce resource use as well as admissions and length of stay for cancer patients.

The report identified oncology-focused alternative payment models as the key to lowering cancer care costs.

But Greenup emphasized that greater healthcare cost savings can be realized without sacrificing care quality by promoting evidence-based radiation treatment utilization.

“In conclusion, our study highlights an underused opportunity for high-value cancer care within breast oncology,” researchers wrote. “Opportunities exist for patients to receive high-quality breast cancer care at reduced costs, and these options should be encouraged in the clinical setting as long as oncologic outcomes and patient autonomy can be maintained.”

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