Costs Rise When Patients and Specialists Embrace a New Technology for Treating Prostate Cancer

Roughly one in three Medicare beneficiaries diagnosed with prostate cancer today gets a sophisticated form of radiation therapy called IMRT. Eight years ago, virtually no patients received the treatment.

The story behind the sharp rise in the use of IMRT—which stands for intensity-modulated radiation therapy—is about more than just the rapid adoption of a new medical technology. It's also about financial incentives.

Expensive new procedures like IMRT play no small role in the relentless rise of Medicare expenditures. This year, the federal health-insurance program for the elderly and disabled is expected to spend $524 billion on the care of its 47 million beneficiaries—a 40% increase from 2006. The Congressional Budget Office recently projected that federal spending on Medicare could double as a share of gross domestic product to as much as 7% by 2035.

“A Device to Kill Cancer, Lift Revenue, “ Wall Street Journal, December 8, 2010

The main problem with the health reform law is that it does not contain costs.
One reason may be that when a non-invasive, painless , effective technology for treating cancer comes down the health care pike, word quickly gets around among specialists and patients.

When patients are on Medicare and are unaware of costs, and specialists deploying the device profit from using it, cost is no object and no impediment.

Such is the case with IMRT (Intensive-Modulated Radiation Therapy) machine. The Wall Street Journal ran a 3100 word front page piece yesterday on IMRT, pointing out that that its treatment costs run up to $40,000 for a full course of treatment and questioning whether deploying it is necessary for treating many patients with slow growing tumors.

Four options exist for elderly patients with prostate cancer.

1. Watchful Waiting – Regular visits with monitoring but no treatment. Cost: Minimal

2. Surgery – Prostatectomy. Has risks of erectile dysfunction. Cost: Up to $16,000

3. Seeds – Seeds implanted in prostate to irradiate tumor. Costs: Up to $19,000

4. IMRT - Use of X-ray machine with attachment to direct radiation beam to specific area of tumor. 45 daily treatments over 9 weeks with treatments lasting 10-20 minut

Critics question whether the increase in IMRT increases cure rate, and what role financial incentives play in its popularity. Urologist groups purchase equipment used in the therapy, hire radiation oncologists to operate it, and refer patients for in-house treatment.

Are these groups doing so to capture the procedure’s big Medicare reimbursements. The urologist groups say they are just responding to patient demand, that the arrangement improves the coordination of care and that they also offer other treatment options.

Tweet: Urologists use IMRT (Intensive Modulated Radiation Therapy) to treat prostate ca at costs of up to $40,000. Is this necessary when other Rx may work as well @rreecemd