Cost of palliative external beam radiotherapy (EBRT) utilization for bone metastases secondary to prostate cancer (PC)

• Published in: Journal of clinical oncology Vol. 31; no. 15_suppl; p. e16091
• Main Authors: Nickman, Nancy A., Ye, Xiangyang, Gaffney, David K, Barney, Reed B., Biskupiak, Joseph E., Okano, Gary J., Lee, Vinson C., Arellano, Jorge
• Format: Journal Article
• Language: English
• Published: 20.05.2013
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/jco.2013.31.15_suppl.e16091

Abstract only e16091 Background: Evaluations of palliative EBRT costs for patients with bone metastases are limited. The objective of this study was to summarize documentation of usual care patterns and episode costs of EBRT to bone in deceased men with metastatic PC treated in a United States specialty cancer hospital. Methods: An Electronic Health Record (EHR)-based retrospective review was used to identify deceased PC (ICD-9 185.xx) patients ≥18 years of age with bone metastases (ICD-9 198.5) treated between 1995 and 2012 with EBRT for metastasis and pain management. Variables of interest encompassed patient-specific demographic and clinical characteristics, including length and number of EBRT treatments and total cost of EBRT usage (standardized to 2011$US).Common Procedural Terminology (CPT) codes related to EBRT and hospital assigned visit numbers were used in an algorithm to identify EBRT episodes of care (defined as all billed professional and technical EBRT services provided between initial and final evaluation by radiation oncologist). Bootstrapping (percentile method) was used to approximate the 95% confidence interval for final EBRT cost estimates. Results: A cohort of 176 men were identified; 19 (10.8%) had metastases in >1 site, and an average (±SD) Charlson Comorbidity Index of 6.4 ± 3.9 at metastasis diagnosis (excluding cancer). An average of 5.1 ± 4.6 years elapsed between PC and bone metastasis diagnoses. Prior to bone metastasis diagnosis, patient-reported symptoms included bone pain (54%). All men received at least 1 episode of EBRT, and 89 (50.6%) received >1 episode (range 1-6, median = 2). The length of first episode of EBRT ranged from 1 - 44 calendar days (average ± SD, 13.4 ± 8.4), with an average cost totaling $7,084 ± $4,028. Approximately 70% of costs were attributable to hospital (technical) charges and 30% to physician (professional) charges. Bootstrapping resulted in a 95% confidence interval of total cost between $6,641 and $7,527. Conclusions: Results suggest thatpalliative EBRT may constitute a significant burden in time and healthcare system costs.