Cost of Care Related to Treatment of Bone Metastases: Real World Data from a National Health Insurance Provider

Abstract

<h3>Purpose/Objective(s)</h3> Bone metastases are a common occurrence in patients with advanced stage malignancy, often impacting quality of life. Radiation has been, and remains, a highly effective modality for the treatment of symptomatic bone metastases. Various radiation fractionation schemes and techniques exist and are used across the United States in these patients. The cost of care presumably varies significantly based on those factors (technique and number of fractions). We accessed payer claims data from a health insurance provider in Pennsylvania, Delaware, and West Virginia to help determine the actual cost of care for patients with bone metastases treated with radiation. <h3>Materials/Methods</h3> This study was a secondary data analysis of medical claims data using a retrospective design among insured members in Pennsylvania, Delaware, and West Virginia with an ICD-10 code of C79.51 and history of radiation therapy billed under that code from 1/1/2016 to 9/30/2021. Patients were grouped by age, sex, and geographical region. Number of claims and total cost of care were tabulated by year. We also examined which radiation technique was used (intensity modulated radiation therapy (IMRT) vs. 3D conformal radiotherapy (3D CRT) vs. complex isodose plan) based on CPT codes. Lastly, we looked at the use of image guided radiation therapy (IGRT) over that same time period, again using CPT codes. <h3>Results</h3> We identified 29,201 patients treated with radiation for diagnosis code C79.51 between 2016 and 2021. The median number of claims per year was 4,866 (2,744-6,000). Fifty-one percent of patients were male (13,676). The majority of patients (79%) resided in Pennsylvania. The median total cost of care related to ICD-10 C79.51 was $181,918,217 ($163,672,315-$183,565,407). The median number of claims for those years was 95,024 (89,870-101,449). The number of claims per patient varied from 2.3-5.0 and 3.5-10.2 for isodose complex treatment and IMRT, respectively. Most patients were treated using isodose complex technique or 3D CRT (combined 80-90%) with a relatively even split. The use of IMRT remained relatively stable over the timeframe (5-15%). The use of IGRT increased over time, with highest number of claims for IGRT being 2020 (458 claims) (median 266, range: 183-458). The median cost per year for all care related to ICD10 C79.51 was $10,887,581, $7,274,264, and $1,902,141 for patients treated with 3D CRT, IMRT, and isodose complex, respectively. <h3>Conclusion</h3> Radiation remains a widely used technique for the palliation of bone metastases. The cost of care related to its use are significant. The use of IGRT increased over time, with no obvious impact on overall cost of care. The use of IMRT remained low for bone metastases, with an associated increase in cost of care. The overall cost of care remained lowest for those patients treated with isodose complex treatment.