Monday, October 20, 2014: 4:15 PM

Heather Taffet Gold, PhD, NYU School of Medicine and Cancer Institute, New York, NY, Dawn Walter, MPH, New York University School of Medicine, New York, NY, Eleni Tousimis, MD, Georgetown University School of Medicine, Washington, DC and Mary Katherine A. Hayes, MD, Weill Cornell Medical College, New York, NY
Purpose: New technology may inadvertently increase costs of care and diffuse into practice without long-term effectiveness evidence. Brachytherapy-based accelerated partial breast radiotherapy (RT) for early breast cancer serves as a case study of this phenomenon. Accelerated partial breast RT targets RT in a 5-day, twice-daily course compared to traditional whole breast RT (once-daily for 4-7 weeks).

Method: Using Medicare claims data for 47,869 beneficiaries undergoing RT after lumpectomy from 2005-2007, we estimated RT-specific and one-year total costs for inpatient, outpatient and physician services using generalized linear models with log link and gamma distribution. In multivariable analyses, we accounted for RT complications, race, rural residence, age, comorbidities, and censoring from death.

Result: Unadjusted average payment for radiation treatment was $6,260 for whole breast RT vs. $10,470 for brachytherapy-based RT (difference: $4200,p<0.0001), while unadjusted one-year total payment was $9,460 for whole breast RT and $12,180 for brachytherapy=based RT (difference: $2720,p<0.0001). Multivariable analyses indicate that brachytherapy treatment cost 1.66 times more than whole-breast RT (95%CI:1.62-1.70). Adjusted one-year total payments were 31% higher for those receiving brachytherapy (95%CI:1.23-1.39), 45% higher for subjects experiencing complications (95%CI:1.4-1.51)(interaction of brachytherapy*complications, N.S.), and increasingly higher with number of comorbidities (cost ratios: 1.20, 1.54, and 2.35 for 1, 2, and 2+ comorbidities, respectively, p<0.0001). For every 10,000 women undergoing brachytherapy-based RT instead of whole breast RT, we could expect an additional $40million in treatment costs, or an additional $29million in overall 1-year costs.

Conclusion: This new treatment modality increased healthcare costs before long-term evidence proved its effectiveness. These funds could have been used instead to develop additional RT treatment registries to gather sufficient evidence of effectiveness and to create appropriate financial payment models to curb use outside of research studies.