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Practice-Level Spending Variation for Radiation Treatment Episodes Among Older Adults With Cancer.

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Radiation spending for cancer care varies significantly across practices, even after adjusting for patient and treatment factors. This highlights potential cost savings through alternative payment models.

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Area of Science:

  • Oncology
  • Health Services Research
  • Health Economics

Background:

  • Radiation therapy is a critical yet costly aspect of cancer treatment.
  • Understanding spending trends and practice variations is crucial for optimizing healthcare costs.
  • Identifying factors influencing cost variations can inform payment model design.

Purpose of the Study:

  • To analyze trends in radiation therapy spending from 2009 to 2020.
  • To identify factors contributing to practice-level variations in radiation spending.
  • To inform the design of alternative payment models for cancer care.

Main Methods:

  • A population-based, cross-sectional study of fee-for-service Medicare beneficiaries (2009-2020).
  • Analysis of standardized 90-day radiation treatment spending, examining variations by radiation type and fractions.
  • Linear regression models with practice random effects were used to assess spending variations.

Main Results:

  • Mean 90-day standardized spending was $13,683, with high practice-level variation ($4,121 SD after year adjustment, $1,487 SD after further adjustments).
  • Spending increased slightly from 2009-2020, while the number of fractions decreased and use of advanced technologies (intensity-modulated, proton) increased.
  • Significant practice-level variation in spending persisted even after adjusting for numerous patient and treatment characteristics.

Conclusions:

  • Substantial variation exists in practice-level radiation spending and treatment intensity for older cancer patients.
  • These variations occur within and across healthcare markets.
  • Opportunities for cost savings may exist within population-based payment models.