Post-IMRT complications run up costs

The incidence of gastrointestinal (GI) complications following intensity-modulated radiation therapy (IMRT) for prostate cancer is considerable, and GI complications in this setting add more than $3,000 to the cost of care for a Medicare beneficiary, say the authors of a large study from Harvard Medical School, Brigham and Women’s Hospital, and Dana-Farber Cancer Institute in Boston that Urology Times Editorial Consultant J. Brantley Thrasher, MD, called an important examination of cost versus benefit.

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“Medicare spending associated with post-IMRT GI complications is often in excess of 10% of IMRT cost,” said first author Monica J. Wood, who presented the findings at the Genitourinary Cancers Symposium in Orlando, FL.

“It’s important to know that even though GI complications with IMRT are fewer compared with other forms of radiation therapy, there’s still a significant amount of GI complications that are associated with increased costs from the spender’s perspective. With our health care system, which is under a lot of cost control pressure from payers and consumers, it’s important for us to know whether these complications are associated with a significant amount of spending,” said Wood, a medical student at Harvard Medical School who worked on the study with Paul Linh Nguyen, MD, and co-authors.

Using Surveillance, Epidemiology, and End Results-Medicare linked data, researchers examined the incidence and predictors of GI complications in 11,781 men with non-metastatic prostate cancer who underwent definitive IMRT and had no pre-existing GI toxicity and at least 36 months of follow-up after initiating IMRT. Annual incremental spending was defined as the total Medicare payments in the year after development of a first GI complication minus the total Medicare payments in the year preceding the diagnosis of prostate cancer.

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The incidence of post-IMRT complications was 26.5% over 36 months. Anticoagulation therapy (odds ratio [OR]: 1.11; p<.03) and brachytherapy boost (OR: 1.18; p<.001) increased the risk of developing IMRT-related GI complications.

“We’re trying to capture global health care expenditure from the payer’s perspective, so total cost is inclusive of various things such as laboratory studies, visits to the doctor, and specific procedures needed as a result of complications. This gives us a better sense of what the overall health care system needs to spend to take care of these complications,” Wood said.

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The median annual incremental cost per patient associated with post-IMRT GI complications was $3,375 (p<.0001). Among patients with post-IMRT GI complications, the presence of diabetes was associated with an additional $610 (p=.003) per patient in annual incremental Medicare spending.

“We’re assuming that these patients and other patients would have a similar level of other potential complications, such as genitourinary complications and erectile dysfunction, so we’re thinking that those GI complications are responsible for an overall increase in health care spending,” she said. “Associated with that, if there are any technologies or any way to reduce GI complications, we can use these data as a benchmark to see what those cost savings might be. If there is a novel technology or something that we can do to reduce GI complications associated with IMRT, then this is a way for us to estimate what the value of that technology might be.”

Urology Times Editorial Consultant J. Brantley Thrasher, MDUrology Times Editorial Consultant J. Brantley Thrasher, MD, told UT the paper is important "because it represents one of the first attempts to truly quantify the cost of the GI complications associated with intensity-modulated radiation therapy."

"IMRT is a frequently used mode of conformal radiation therapy that attempts to more accurately deliver higher doses of radiation therapy to areas where there are larger amounts of cancer and smaller doses to areas with less cancer. However, it is expensive, and there haven't been a lot of studies looking at the additional cost to the health care system associated with some of the side effects seen with this form or radiation delivery," said Dr. Thrasher, professor and chair of urology at the University of Kansas, Kansas City, who was not involved with the study.

"I believe more studies of this nature are needed as health care dollars are becoming increasingly scarce, and we need to truly evaluate the cost versus benefit ratio of our new technologies."

Dr. Nguyen is a consultant/adviser to Abbott Pharmaceuticals, GenomeDx, and Medivation.

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