Healthcare Cost Analysis of Short-Course vs. Long-Course Pre-Operative Radiotherapy Schedules for Rectal Cancer

Abstract

Purpose/Objective(s)One aspect of alternate radiotherapy (RT) techniques for rectal cancer not well studied in the United States is cost. Herein, we report a financial analysis to assess cost savings associated with short course (SC) versus long course (LC) RT and determine which parties (payor, patient, or both) benefit from the aforementioned savings.Materials/MethodsA focused analysis on neoadjuvant RT for operable rectal cancer was designed to study four regimens: (1) SC utilizing three-dimensional conformal RT (3DCRT) [SC-3D], (2) SC utilizing intensity-modulated RT (IMRT) [SC-IMRT], (3) LC utilizing 3DCRT [LC-3D], and (4) LCRT utilizing IMRT [LC-IMRT]. Variable and fixed patient costs were reported. Patient and payor costs based on regimen were summated to determine societal costs. A sensitivity analysis based on 40 rectal cancer patients per year using SC and LC RT was performed.ResultsTechnical costs account for most of the disparity between payor costs when selecting between IMRT and 3D ($2,472.25-7,623.13), while professional costs remain somewhat stable ($651.25-1,645.58). LCRT-related patient costs ($1,382.94) were found to be higher than SCRT patient costs ($353.22) as patients undergoing LCRT had a greater number of treatment days. This disparity persists when evaluating total societal cost, as the costliest regimen, LC-IMRT ($20,810.77), is almost twice the next expensive regimen, LC-3D ($11,503.00).ConclusionSocietal burden varies significantly with technique and length of treatment for pre-operative rectal cancer RT. Anticipated changes in health policy and reimbursement patterns are likely to disincentivize routine LC and IMRT use in rectal cancer. Further study into patient-centric and resource-conscious medical decision making is warranted. One aspect of alternate radiotherapy (RT) techniques for rectal cancer not well studied in the United States is cost. Herein, we report a financial analysis to assess cost savings associated with short course (SC) versus long course (LC) RT and determine which parties (payor, patient, or both) benefit from the aforementioned savings. A focused analysis on neoadjuvant RT for operable rectal cancer was designed to study four regimens: (1) SC utilizing three-dimensional conformal RT (3DCRT) [SC-3D], (2) SC utilizing intensity-modulated RT (IMRT) [SC-IMRT], (3) LC utilizing 3DCRT [LC-3D], and (4) LCRT utilizing IMRT [LC-IMRT]. Variable and fixed patient costs were reported. Patient and payor costs based on regimen were summated to determine societal costs. A sensitivity analysis based on 40 rectal cancer patients per year using SC and LC RT was performed. Technical costs account for most of the disparity between payor costs when selecting between IMRT and 3D ($2,472.25-7,623.13), while professional costs remain somewhat stable ($651.25-1,645.58). LCRT-related patient costs ($1,382.94) were found to be higher than SCRT patient costs ($353.22) as patients undergoing LCRT had a greater number of treatment days. This disparity persists when evaluating total societal cost, as the costliest regimen, LC-IMRT ($20,810.77), is almost twice the next expensive regimen, LC-3D ($11,503.00). Societal burden varies significantly with technique and length of treatment for pre-operative rectal cancer RT. Anticipated changes in health policy and reimbursement patterns are likely to disincentivize routine LC and IMRT use in rectal cancer. Further study into patient-centric and resource-conscious medical decision making is warranted.