An opportunity to save? SBRT is less costly than IMRT for intermediate-risk prostate cancer

Stereotactic body radiation therapy (SBRT) is a novel form of radiotherapy for prostate cancer which uses ultra-hypofractionated radiation and allows for fewer treatment sessions compared to moderately hypofractionated regimens including intensity-modulated radiation therapy (IMRT). Recent studies have demonstrated comparable oncologic outcomes between SBRT and IMRT for intermediate-risk prostate cancer. We sought to compare the cost of SBRT and IMRT for intermediate-risk prostate cancer.

We identified men over age 66 diagnosed with intermediate-risk prostate cancer who underwent IMRT or SBRT from 2008 to 2017 using the Surveillance, Epidemiology and End Results-Medicare Linked Database to compare per patient radiation-specific costs. Patients who received a therapeutic regimen, defined as ≥20 fractions of IMRT and ≥2 fractions of SBRT within 90 days, were included. Additionally, only patients treated in 1 locality was included to account for geographic variability in healthcare costs. Linear mixed-effects regression was used to compare per patient costs.

The final cohort included 934 IMRT patients and 237 SBRT patients. Our adjusted model showed the estimated total cost per patient was $20,130 for IMRT and $9,259 for SBRT (P < 0.01). Predictors of higher cost included residing in high-density areas, higher education levels, higher median household income, and earlier years of radiation treatment.

SBRT has significantly lower radiation-specific costs compared to IMRT for intermediate-risk prostate cancer. Our findings support the adoption of SBRT for the treatment of localized prostate cancer to lower healthcare costs while maintaining quality prostate cancer care.