Abstract
PurposeHistorically, opaque health care pricing in the US has prevented patients from identifying opportunities to lower costs. Attempting to promote price transparency, the US government recently mandated that hospitals publish prices for all services in a document called a chargemaster. Patients often travel to tertiary centers for intracranial stereotactic radiation therapy (SRT), but cost comparison is complicated by multiple delivery systems and fractionation schemes. We hypothesized that prices published in chargemasters vary widely between SRT techniques and institutions. Methods and MaterialsWe obtained chargemasters published online by National Cancer Institute–designated clinical centers. Technical charges for Gamma Knife single-fraction stereotactic radiosurgery (GK), single-fraction linear-accelerator stereotactic radiation surgery (SRS), and 3-fraction fractionated stereotactic radiation therapy (FSRT) were obtained from chargemasters by billing code and keyword searches. Prices were adjusted by the Medicare geographic cost price index (GPCI). Pairwise comparisons were conducted to compare prices between modalities and geographic regions. Relationships with cost index were examined using Spearman correlations, as was the price interrelationship between modalities across institutions. ResultsOf 62 chargemasters obtained, 58 listed SRT prices. Median prices were $49,529 for GK, $31,834 for FSRT, and $22,915 for SRS. Prices varied widely, with large ranges corresponding to 2 to 9 times the magnitude of median prices (GK, $111,298; FSRT, $312,480; and SRS, $104,396). Adjusting for GPCI, GK (P = .0003) and FSRT (P = .001) were more expensive than SRS, and no difference in price was noted between regions. The FSRT price was positively correlated with GPCI (P = .033), but prices for the other techniques were not. Modality prices were all positively correlated (all P < .001), meaning that institutions with prices greater than the median price for SRS were similarly expensive for GK and FSRT. ConclusionsPublished prices for SRT vary by delivery system, fractionation, and institution without a clear explanation. Obtaining personalized price estimates may offer cost savings for patients. Policy changes encouraging reliable access to insurer-negotiated cost estimates for SRT are needed.
Highlights
Advances in Radiation Oncology: XXX 2021 that of their peers,[3] and economic hardship is linked to poorer quality of life and cancer outcomes.[4,5,6,7] Inability to make copayments[8] is a considerable cause of economic distress, and opaque health care pricing frequently exposes patients to unexpected and crippling out-ofpocket bills.[9]
In 2019, the US Centers for Medicare & Medicaid Services (CMS) required that all US hospitals publish a comprehensive list of charges for all offered services, called a chargemaster,[10] with the aim that improved price transparency would drive down costs by encouraging price comparison by all stakeholders including patients, insurers, and providers
Price comparison is complicated by the presence of multiple delivery systems and fractionation schemes including Gamma Knife or CyberKnife single-fraction stereotactic radiation surgery (GK), singlefraction linear accelerator−based stereotactic radiosurgery (SRS), and multisession linac-based fractionated stereotactic radiation therapy (FSRT)
Summary
Advances in Radiation Oncology: XXX 2021 that of their peers,[3] and economic hardship is linked to poorer quality of life and cancer outcomes.[4,5,6,7] Inability to make copayments[8] is a considerable cause of economic distress, and opaque health care pricing frequently exposes patients to unexpected and crippling out-ofpocket bills.[9]. Intracranial stereotactic radiation therapy (SRT) is well suited for price comparison, because it is a high-cost, nonemergent, and short-duration (1 to 5 daily treatments) intervention with numerous benign and malignant indications[11] for which patients are frequently referred to high-volume centers.[12] Financial toxicity is defined as the financial burden encountered by patients receiving cancer therapy, a broad definition intended to encompass both subjective and objective measures of economic distress.[8,13] Whereas the financial toxicity rate of SRT has not been prospectively studied, a rate of early-onset financial toxicity of more than 20% has been noted after definitive radiation therapy, suggesting that patients receiving SRT may be at high risk for therapy-related economic harm.[14] Multiple referral centers may exist within a city, state, or region, and reliable cost data, if available, could help patients choose a facility that minimizes out-ofpocket costs. Price comparison is complicated by the presence of multiple delivery systems and fractionation schemes including Gamma Knife or CyberKnife single-fraction stereotactic radiation surgery (GK), singlefraction linear accelerator (linac)−based stereotactic radiosurgery (SRS), and multisession linac-based fractionated stereotactic radiation therapy (FSRT). We hypothesized that published prices for intracranial SRT listed in chargemaster documents would vary by fractionation scheme and between institutions
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
