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Quantifying the Role of Interventional Radiology in Managing Patients with Hepatobiliary Cancers
Nishita Kothary1, C Matthew Hawkins2, Ashley Maleki3
1Division of Interventional Radiology, Department of Radiology, Stanford University School of Medicine, Palo Alto, California.
Purpose:
To quantify the role of interventional radiology (IR) in managing primary and secondary hepatobiliary cancers.
Materials And Methods:
This retrospective study analyzed administrative data from the Centers for Medicare & Medicaid Services (CMS) using final action claims for Medicare Fee-for-Service beneficiaries from 2016 to 2021. Patients aged ≥65 years with hepatobiliary cancer were identified using International Classification of Diseases (ICD), 10th Revision, codes. Services and associated work Relative Value Units (wRVUs) provided by IR, medical oncology, radiation oncology, and surgical oncology were identified using CMS physician specialty codes. IR procedures were classified as therapeutic or supportive.
Results:
From 2016 to 2021, the Medicare hepatobiliary cancer cohort included 108,317-111,761 patients annually (mean age, 75 years; male, 53%). Medical oncologists treated 70% of patients, followed by interventional radiologists with 51%, radiation oncologists with 13%, and surgical oncologists with 5%. Physician service volumes and wRVU remained stable, with medical oncologists providing the largest share (69% of services and 13.7% of wRVUs), followed by interventional radiologists (2.9% and 11.7%, respectively), radiation oncologists (1.3% and 4.5%, respectively), and surgical oncologists (0.1% and 2.2%, respectively). Interventional radiologists performed 75,785 therapeutic procedures, primarily for hepatocellular carcinoma (59%). Before pandemic, IR volumes increased 57%, driven by liver ablations (+25%) and supportive services (+63%), whereas transarterial therapies declined slightly (-6%). Despite the drop in volume during the pandemic, IR saw the highest compound annual growth rate (4%) among the specialties analyzed.
Conclusions:
IR provides a substantial share of services for patients with hepatobiliary cancers, with rising use of therapeutic and supportive services, delivering similar wRVUs at lower costs, underscoring its growing role in cancer care.
