Economic Issues in 3DCRT and IMRT

S. Jack Wei, MD
Abramson Cancer Center of the University of Pennsylvania
Last Modified: October 22, 2003

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Moderator: Theodore L. Phillips, MD., University of California, San Francisco

Jeffrey M. Michalski, MD, MBA, Washington University, St. Louis

  • There are several key questions regarding a treatment when performing an economic analysis:
    1. Can the intervention work? Efficacy (compliance)
    2. Does the intervention work? Effectiveness
    3. Does the intervention reach those who need it? Availability
  • The costs and consequences of these treatments need to be examined.
  • There several types of cost analyses that can be performed:
    1. Cost effectiveness: The costs of a treatment need to be related to a common effect (e.g. lives saved, xerostomia)
    2. Cost minimization: Finds the lower cost of 2 treatments with similar treatment outcomes.
    3. Cost benefit: Relates the cost of treatment to incremental benefit. Outcomes may differ between treatments but are often translated into a monetary value.
    4. Cost utility: Refers the outcomes to the preferences of society (e.g. quality-adjusted life years) and avoids monetary terms.
  • It is important to remember that costs do not equal charges.
  • As a surrogate for cost, we often use market price of equipment, reimbursement, cost-to-charge ratios, etc. These may underestimate the cost and therefore show increased value of a treatment.
  • We must also consider the learning curve associated with IMRT. The time of cost analysis is important as planning and delivery become faster as we become more familiar with the technology, thereby lowering the cost of treatment.
  • We should also consider that IMRT will likely be subject to economies of scale as more institutions employ IMRT.
  • As an update to the proposed reductions in reimbursement for IMRT, it was found that the top 4 providers of IMRT accounted for one-third of all IMRT claims.
  • Providers were billing for IMRT planning 5 times a week rather than for billing for treatment.
  • Physicians must use IMRT properly, code for billing properly, and support trials showing IMRT efficacy in order to combat the potential cuts in reimbursement.


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