Number of doses, delivery system and setting impact radiation price tag

When cancer spreads to the bone, radiation treatments can help relieve the pain caused by the tumor. But how best to deliver the radiation may vary widely from one oncologist to the next.

A new analysis from researchers at the University of Michigan Comprehensive Cancer Center shows cost also varies widely from one delivery method to the next. Costs can range from around $1,700 for a single treatment with conventional radiation techniques to more than $16,000 for four treatments using a system of radiation delivery called Cyberknife.

"Some of the technologies that have been shown to be safe and effective, but have not been shown to be superior, can cost up to 10 times what a single dose of conventionally delivered radiation costs," says David D. Howell, M.D., assistant professor of radiation oncology at the U-M Medical School and medical director of radiation oncology at the Norval K. Morey Cancer Center in Mt. Pleasant, Mich., part of the U-M Radiation Oncology Network.

Howell presented the results this week at the Breast Cancer Symposium in San Francisco, a meeting sponsored by six leading cancer organizations.

Research has shown a single treatment with standard radiation can be equally effective as 10 treatments of standard radiation when it comes to relieving pain associated with cancer that has spread to the bone. Fewer treatments also spare patients and their caregivers from more trips to the radiation department.

But some doctors believe that delivering radiation using more recently developed technologies for radiation delivery, such as stereotactic radiosurgery or Cyberknife, will yield better pain control or fewer side effects in the long term for certain patients. Studies to date have not unequivocally confirmed these views, and research is ongoing.

Most radiation oncologists will consider a variety of factors in choosing a treatment strategy, such as the location and type of cancer, how well it may respond to radiation as well as the patient's previous and current cancer treatment.

"In considering the big picture of patient care and treatments for cancer, safety, efficacy, side effects, the patient's time commitment and comfort all should enter into the mix. Cost is another parameter that should be considered," Howell says.

Methodology: The researchers used regional Medicare reimbursement codes to look at reimbursements associated with seven different radiation treatment scenarios for cancer that has spread to the bone. This included the number of treatments given, the setting of either freestanding center or hospital-based center, and the use of one of three different radiation technologies: Cyberknife, stereotactic radiosurgery and conventional radiation.