An economic analysis of single fraction radiotherapy for treatment of hospice patients with symptomatic bone metastasis

Abstract

8031 Background: Fifty percent of hospice patients have cancer, though few receive palliative radiotherapy. The Medicare hospice per diem of $114 may inhibit the use of more costly treatments. Recent trials have confirmed equal efficacy of single versus multiple fraction radiotherapy in the palliation of painful bony metastasis, and here we present an economic model estimating the range of costs for single fraction radiotherapy. Methods: We model Medicare reimbursement for single fraction radiotherapy to two hypothetical patients, each with one site of painful bony metastasis. We first choose a situation that allows use of the most economical consultation, treatment planning, and treatment delivery. We then investigate a case with a radiation sensitive normal structure adjacent to the treated area that necessitates more complex intervention. We assume no charge for a single follow-up visit 4 weeks after treatment. Results: Assuming a conversion factor of $36.70 per relative value unit and the 2003 fee schedule, the lower complexity treatment costs $630 and includes charges for codes related to limited consultation ($88), treatment management ($93), simple simulation ($168), basic dosimetry ($83), simple isodose plan ($107), pre-treatment port film ($23), and simple 6 MV treatment delivery ($68). For the more complex case, the total cost is $1154 and reflects increases in charges for codes representing more complex consultation ($173), simulation ($327), 6MV treatment delivery ($89), and isodose plan ($180), as well as the addition of a complex treatment device ($186). Using the same assumptions, the estimated cost for ten fractions ranges from $1508 to $2221. Conclusions: Though single fraction radiotherapy is more economical than the commonly used ten fraction schedule, that single treatment still costs 5 to 10 times more than the average hospice per diem. Single fraction therapy is not likely to be offered unless it leads to earlier referral to hospice, allowing the hospice program to recover some of the cost of treatment. Alternatively, we recommend adding an outlier payment system for delivery of radiotherapy to hospice patients. No significant financial relationships to disclose.