Abstract PD7-04: Contribution of radiation therapy to the overall cost of cancer care for clinical stage IA breast cancer patients

Abstract

Abstract Background: Cost of cancer care continues to rise and there is an increasing interest in episode-of-care and bundled payments. Radiation therapy is a well-established component of clinical Stage IA breast cancer care. However, the contribution of radiation to the cost of breast cancer care is not well understood. We were interested in evaluating the contribution of radiation cost to our overall Cancer Center breast cancer care cost, by using revenue received as a proxy. Methods: Patients with clinical Stage IA breast cancer managed completely at our Cancer Center between 1/1/2014 and 12/31/2014 were identified from cancer registry. An IRB-approved retrospective review of clinical charts and financial data of patients was performed. Individual chart review identified whether and which kind of surgery, chemotherapy, and radiation therapy was delivered. Financial review identified actual technical revenue received for 365 days after the date of first contact, and apportioned it accordingly to the various cost centers, including radiation oncology. All patients were included regardless whether they were Commercial, Medicare, Medicaid, self-pay, or free-care. Results: There were 110 patients treated with clinical Stage IA breast cancer. All patients (100%) underwent surgery (lumpectomy 69%; mastectomy 5%, mastectomy with reconstruction 26%). Chemotherapy was delivered in 20% of patients (neoadjuvant 13%; adjuvant 7%). Seventy seven percent saw a radiation oncologist, and 57% received radiation therapy. Radiation technique was 3D in 92% and IMRT in 8%. Fractionation was conventional in 55%, accelerated in 43%, and APBI in 2%. Most common treatment pathways were lumpectomy with radiation (46%), mastectomy with reconstruction alone (18%), and lumpectomy alone (14%). Concordance with national guidelines was ≥90%. Overall cost of care for these patients was $6.3 million. Medicare accounted for 35% of patients. Radiation cost was $1.1 million (17%), compared with $2.1 million (33%) for surgery, $2.4 million (38%) for chemotherapy, and $0.7 million for other costs (imaging, lab, ED visits, etc). Conclusions: Radiation therapy was used in ˜60% of clinical Stage IA patients, but accounted for only ˜20% of the overall cost to the health care system. Given the demonstrated survival benefit of radiation therapy in the care of breast cancer patients, and our high concordance with national guidelines, radiation therapy in our Cancer Center provides high value to our patients, as we move toward value-based episodes of care. Citation Format: Dvorak T, Coltey D, Waters J, Kelly P, Buchholz D. Contribution of radiation therapy to the overall cost of cancer care for clinical stage IA breast cancer patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD7-04.