"Our analysis demonstrates a real need for novel reimbursement strategies that simultaneously incentivize the implementation of such clinically important treatments while still promoting cost-effectiveness," Smith said in a statement.

The researchers also found regional variations in the definition of a related radiotherapy treatment might have influenced costs.


In the paper, they noted that field-in-field forward planning, a radiotherapy technique that's more straightforward and requires less planning time than IMRT but has potentially comparable clinical results, is generally not billable as IMRT delivery by most Medicare Carriers. As a result, in those regions where it's not billable as IMRT, it would be only slightly more expensive than non-IMRT treatments. However, in areas where it does meet IMRT billing criteria, it could costs thousands of dollars more.

"This type of geographic variation in Medicare payments has been previously cited, both in the lay press and in health policy circles, as a potential source of waste within the Medicare system," the authors write. "Our data suggest that with respect to breast radiation therapy much of the variation in cost can be directly attributed to inconsistent treatment definitions and reimbursement rates authorized by Medicare and its intermediaries."

Nonetheless, the study had a number of limitations. It only looked only at older women, and the authors concede that younger women might receive IMRT more often because of concerns over radiation's future toxic effects. Also, the study only captured IMRT billing data; it was not validated by a chart review, the "gold standard" for this type of study. And because it used Medicare data, it does not capture patient co-payments and so might not reflect the cost for patients with private insurance or the true cost of providing radiation therapy.

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