Lack of price transparency for prostate-directed radiation therapy relative to radical prostatectomy.

Abstract

1579 Background: For patients with low to favorable-intermediate risk prostate cancer (PC), management with active surveillance, radical prostatectomy (RP), external beam radiation therapy (EBRT), and brachytherapy (BT) are all National Cancer Center Network-supported definitive monotherapy options. Because therapy is non-urgent and choosing therapy can be complex, patients routinely seek second opinions and cost can be an important consideration. Recent federal price transparency (PT) guidance requires hospitals to provide payer-negotiated prices for ≥300 common services in a “shoppable,” user-friendly, online format. 70 services, including RP, are specified, while the remainder are left to institutional discretion. Despite equipoise between radiation therapy (RT, inclusive of EBRT and BT) and RP in definitive treatment for PC, inclusion of prices for RT is optional. National Cancer Institute (NCI)-designated cancer centers (NCI-CC) are high volume referral centers who have the option to volunteer prices for RT; the rate at which NCI-CC choose to report payer-negotiated price estimates for prostate-directed RT is unknown. We hypothesize that reporting rates for BT and EBRT are significantly lower than for RP. Methods: Through online query, we identified “shoppable” price tools for NCI-CC in December 2021. Using billing codes and keyword searches, we queried these price tools for cost estimates for RP, EBRT (delivered using intensity modulated radiation therapy), and BT. Descriptive statistics, include frequency counts and proportions, were performed. The rate of reporting of “shoppable,” negotiated prices for each therapy was assessed. These rates were compared using the chi-squared test (significance level of α = 0.05). Results: Of the 63 NCI-CC offering clinical care, 58 (92%) published “shoppable” tools. 6 (10%), 7 (11%), and 51 (81%) published “shoppable” prices for EBRT, BT, and RP, respectively, demonstrating a significantly higher rate of publication of prices for RP than for EBRT or BT ( P < 0.001). All of the published prices for BT were for high dose rate BT. The 11 Medicare Prospective Payment System–exempt NCI-CC had the highest rates of reporting “shoppable” prices at 91%, with 64%, 27%, and 36% including prices for RP, EBRT, and BT, respectively. Conclusions: Under existing regulations, patients with PC can obtain payer-negotiated price estimates for EBRT and BT from just roughly 10% of NCI-CC, while price estimates for RP are offered by > 80% of these institutions. This represents a potential obstacle to informed decision making, undermines the stated goals of US PT health policy, and the impact on utilization rates (or patient choice of therapy) is unknown. Moving forward, mandating the inclusion of common RT services (EBRT and BT) in “shoppable” price tools is a straightforward intervention that may be highly beneficial in this common cancer population.