ASTRO 2015

Economics of radiation therapy

Ron DiGiaimo – Revenue Cycle Inc, Austin, USA

What brings you here to ASTRO?

One of the things that I wanted to look at, or numerous things, I wanted to trend what the clinical outcomes and the changes that are going on with all the different diagnoses. Dr Chun recently spoke of some innovative ways of treating lung cancer; there are many presentations that are talking about hypofractionation with regard to prostate and what does that really translate to is that a patient who might have normally had, in the case of prostate, eight weeks of treatment is now having one to four weeks. Of course there are all kinds of economic implications with that but if you look at that what is the benefit to the patient? Reduced time, increased quality of life, no measurable increase of side effects plus if we look at our Medicare system in the United States, and it’s heavily burdened, a large part of it is due to oncology. If we start looking at our increased numbers that are coming in and we start looking at increased efficacies and reduced treatment times the concern might be what is the effective economics? Well, now one-third of patients either delay or eliminate treatment altogether out of equal concerns. The concerns today with some of these patients are they worry as much about how they are going to pay the bill as the cancer itself. That’s a terrible statistic. When you start looking at reduced fractionation with equal outcomes you have a reduced burden on the patient, you have a reduced burden on our overall economy but now it enables us in radiation oncology to use that, those outcomes, and get better case rates, get better payments with regard to IMRT, with regard to protons, which are relatively new and expanding and growing throughout the country. All of those are the reasons that I’m here to look at hopefully helping the patient, the facility and a win-win-win for the facility, the physician and the patient as well.

Could you comment on the possible economic considerations of using IMRT versus 3DCRT in the study Dr Chun presented?

What he’s talking about is a change. If you look at 3D there are numerous extended treatments. If we look at IMRT, while on the short it might be a little increased per fraction, when we start looking at reduced fractions and reduced overall care for the patient the economic benefit to the entire healthcare system is enormous. It’s my job to know what those statistics are and help educate hospitals and physicians and patients around the country.

How can the higher cost of IMRT or other newer radiation therapy methods be justified over more traditional approaches?

How you justify the cost of IMRT over protons is benefit to the patient quality of life. In my personal opinion you can’t really put a price on that. But if we have to put a price on that and we start reducing the overall number of fractions that occur with equal outcomes, critics disappear. But it will take time. The work that Dr Chun and others are presenting here is going to help with that from a clinical standpoint and then, of course, ultimately economics will drive a certain direction.

What are you looking forward to hearing more about here at ASTRO 2015?

I’m looking forward to learning more about the direction of protons. They’ve been under heavy scrutiny worldwide but in particular in the United States. Just less than ten years ago we had two hospital based facilities, one freestanding, now we have over 27, I believe, and numerous under construction and under negotiation. Every major institution in the United States has moved in that direction, they’re here to stay. I’m looking forward to what’s going to go on with carbon ions, helium ions, I think those are particular areas that are future shows and I’m interested in what that will be in the next 5-10 years.

Is there anything else you would like to highlight?

When I first went to school was over 25 years ago, one in four Americans got cancer. Today that statistic is one in three and it’s predicted within the next twenty years to be one in two. So when we start looking at that and we start looking at increased volumes and increased aging population and we start considering hypofractionation and other avenues that reduce time but also increase quality of life, the future might be a little more positive than we originally thought.