You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness III1 Apr 2012422 PROTON BEAM RADIOTHERAPY IN THE US MEDICARE POPULATION GROWTH IN USE IN PROSTATE AND OTHER CANCERS BETWEEN 2006 AND 2009 Sean Elliott, Stephanie Jarosek, and Beth Virnig Sean ElliottSean Elliott Minneapolis, MN More articles by this author , Stephanie JarosekStephanie Jarosek Minneapolis, MN More articles by this author , and Beth VirnigBeth Virnig Minneapolis, MN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.488AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Proton beam radiotherapy (PBR) is an expensive and highly specific form of radiotherapy. It is a small but rapidly growing segment of the radiation oncology practice. Without a national Medicare coverage decision for PBR, local Medicare administrative contractors are free to establish local medical review policies (LMRPs). Generally, these LMRPs consider tumors of the eye, skull base and spine to be ”commonly accepted indications” for PBR. They consider prostate and lung cancer to represent ”conditions of possible benefit” and allow payment as long as special documentation procedures are followed. Because the latter cancers are far more common, we hypothesized that conditions of possible benefit would be largely responsible for the growth in PBR use. METHODS From the 100% Medicare dataset (2006-2009) we isolated claims for receipt of PBR that were associated with any cancer diagnosis. For each year, the number of unique beneficiaries, diagnoses and costs were calculated. We grouped diagnoses by the degree of consistency in LMRP policy regarding PBR. We also described the frequency of PBR at each of the national PBR delivery centers. We assigned PBR recipients to their provider by matching ZIP codes of the service provider to the ZIP codes of the PBR centers operational at the time of the service. RESULTS The number of centers operating in the United States remained constant from 2006 to 2008 at six. One center was added in 2009. However, the number of patients treated increased from 740 patients in 2006 to almost 1300 in 2009 (See Figure). 85% of all proton beam was delivered for conditions of possible benefit (70% for prostate cancer and 7% for lung cancer). Ocular tumors were <7%. Medicare claims for proton beam were $27.2M in 2009. Because prostate cancer is typically treated with 30 sessions vs. only 5 for an ocular tumor, it represents nearly all of the costs to Medicare for PBR. CONCLUSIONS Nearly all PBR is delivered for conditions of possible benefit, rather than for commonly accepted indications. Even though only <1% of men with prostate cancer receive PBR, the high prevalence of prostate cancer establishes it as the most common tumor to be treated with proton beam. Even a minimal growth in future PBR use in prostate cancer will have significant cost implications for the Medicare program. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e173 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sean Elliott Minneapolis, MN More articles by this author Stephanie Jarosek Minneapolis, MN More articles by this author Beth Virnig Minneapolis, MN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...