MSPP06 Presentation Time: 4:50 PM: Price Availability for Prostate Brachytherapy, External Beam Radiation Therapy, and Radical Prostatectomy

Abstract

<h3>Purpose</h3> 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 monotherapy options. Because therapy is non-urgent and choosing between these options can be complex, patients routinely seek second opinions. Expectedly, the cost of therapy can be an important consideration. Recent federal price transparency (PT) guidance requires hospitals to provide payer-negotiated prices for at least 300 common services in a "shoppable," user-friendly, online format. Seventy services, including RP, are specified, while the remainder are left to the discretion of each institution. Even though there is 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 referral centers catering to high volumes of patients with cancer. Although NCI-CC have the option to volunteer prices for RT, the rate at which these institutions choose to report payer-negotiated price estimates for prostate-directed RT is unknown. We hypothesize that reporting rates for BT and EBRT may substantially trail rates of mandatory price reporting for RP. <h3>Materials and Methods</h3> Through online query, we identified "shoppable" price tools for NCI-CC in December 2021. Using Current Procedural Terminology billing codes and keyword searches, we queried these price tools for cost estimates for RP, EBRT (delivered using intensity modulated radiation therapy), and BT. Both high dose rate (HDR) and low dose rate (LDR) BT were considered. NCI-CC were stratified by Medicare Prospective Payment System(PPS)-exempt status; these 11 NCI-CC are exempt from standard Medicare fee for service reimbursement caps. 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 at a significance level of α=0.05. <h3>Results</h3> Of the 63 NCI-CC offering clinical care, 58 (92%) published "shoppable" tools. Seven (11%), 6 (10%), and 51 (81%) published "shoppable" prices for BT, EBRT, and RP, respectively (Figure 1), translating to a significantly higher rate of publication of prices for RP than for EBRT or BT (<i>P</i> < 0.001). All of the published prices for BT were for HDR-BT and none were for LDR-BT. PPS-exempt cancer hospitals had the highest rates of reporting "shoppable" prices at 91%, with 64%, 27%, and 36% including prices for RP, EBRT, and BT, respectively. <h3>Conclusions</h3> Under current federal guidance, patients with PC can obtain online payer-negotiated price estimates for BT and EBRT from just roughly 10% of NCI-CC, while price estimates for RP are offered by more than 80% of these institutions. For patients with PC, this represents a potential obstacle to informed decision making, undermines the stated goals of US PT health policy, and the impact of this unintended effect of PT laws on BT utilization rates (or patient choice of therapy) is unknown. Moving forward, mandating the inclusion of common radiotherapy services (EBRT and BT) in "shoppable" price tools is a straightforward intervention that may be highly beneficial to this patient population.