201 Use and cost of photodynamic therapy in the Medicare population, 2012 to 2016

Abstract

Photodynamic therapy (PDT) is an effective field treatment for actinic keratosis. As the burden of actinic keratosis in the aging U.S. population rises, it is unknown how the utilization and cost of PDT change in the context of competing actinic keratosis treatments, decreasing Medicare reimbursement, and rising cost of topical aminolevulinic acid (ALA). We aimed to assess the use of PDT in the Medicare Part B fee-for-service population in 2012-2016. Aggregated clinician-level claims data were compiled from the Centers for Medicare & Medicaid Services Physician and Other Supplier Public Use Files in 2012-2016. PDT and ALA administration were determined by Healthcare Common Procedure Coding System code 96567 and J7308, respectively. Medicare payments were adjusted to 2016 values using consumer price index. Among 46.5 million to 52.1 million Medicare Part B enrollees, respectively, PDT administration by dermatologists per 100,000 enrollees increased from 182 to 205 in 2012-2016. ALA administration by dermatologists per 100,000 enrollees increased from 209 to 234 in 2012-2016. Medicare payment for PDT per 100,000 enrollees increased by 4% from $19,126 to $19,928 in 2012 to 2016. Medicare Part B payment for ALA administration per 100,000 enrollees increased from $26,385 to $56,100 in 2012 to 2016. Medicare Part B payments for PDT and ALA combined increased by 45% from $45,512 to $76,028 per 100,000 enrollees. This study may underestimate true ALA costs since it lacked Medicare Part D data for patients receiving topical ALA from pharmacies. PDT use has increased and payments per PDT procedure have decreased. Rising costs of topical ALA administration accounted for an increasing proportion of the overall cost burden of photodynamic therapy.