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The Financial Impact of Fractionation Scheme and Treatment Planning Method for Rectal Cancer in the United States

  • Assaf Moore
    Affiliations
    Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Robert B. Den
    Affiliations
    Department of Radiation Oncology, Jefferson University, Philadelphia, PA
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  • Noa Gordon
    Affiliations
    Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel
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  • Michal Sarfaty
    Affiliations
    Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Yulia Kundel
    Affiliations
    Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Baruch Brenner
    Affiliations
    Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Daniel A. Goldstein
    Correspondence
    Address for correspondence: Daniel A. Goldstein, MD, Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599
    Affiliations
    Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC
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      Abstract

      Background

      Preoperative long-course chemoradiotherapy (CRT) and short-course radiotherapy (SCR) for locally advanced rectal cancer (LARC) were found to have equivalent outcomes in 3 randomized trials. SCR has not been widely adopted in the United States (US). Three-dimensional (3D) treatment planning is standard, whereas intensity-modulated radiotherapy (IMRT) is controversial. In this study, we assessed the economic impact of fractionation scheme and planning method for payers in the US.

      Materials and Methods

      We performed a population-based analysis of the total cost of radiotherapy for LARC in the US annually. The national annual target population was calculated using the Surveillance, Epidemiology, and End Results database. Radiotherapy costs were based on billing codes and 2018 pricing by Medicare's Hospital Outpatient Prospective Payment System.

      Results

      We estimate that 12,945 patients with LARC are treated with radiotherapy annually in the US. The cost of CRT with 3D or IMRT is US $15,882 and $23,745 per patient, respectively. With SCR, the cost with 3D or IMRT is $5,458 and $7,323 per patient, respectively. The use of SCR would lead to 53% to 77% annual savings of $106,168,871 to $232,105,727 compared with CRT. IMRT increases the total cost of treatment by 34% to 50%, and if adopted widely, would lead to an excess cost of $24,152,134 and $101,784,723 annually with SCR and CRT, respectively.

      Conclusions

      SCR may have the potential to save approximately US $106 to t232 million annually in the US, likely without impacting outcomes. Lack of evidence showing benefit with costly IMRT should limit its use to clinical trials. It would be reasonable for public and private payers to consider which type of radiation is most suited to reimbursement.

      Keywords

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