To use real-world data to assess trends in radiotherapy (RT) treatment fractionation and cost under the OCM through the first eight Performance Periods (PP).
We identified 17,157 episodes of care from 9,898 patients treated at a statewide multispecialty health system through the first eight six-month Performance Periods (PP1-8; July 1, 2016 to June 30, 2020) of the OCM. Spending stratified by 10 expenditure domains (e.g., Part B/D drugs, radiation oncology [RO], etc.) and 21 disease sites was extracted from claims data, from which an analysis of RO expenditures was performed on 2,219 episodes from 2,033 patients treated with RT. Expenses are expressed in per beneficiary, per episode terms.
RO expenditures comprised 3% ($14.7M) of total spending over the 8 periods. By primary cancer, the largest RO expenses were for breast ($2.9M; 20%), prostate ($2.9M; 19%), and lung cancer ($2.8M; 13%). For RO, total per-episode average spending remained roughly constant between PP1 ($6,314) and PP8 ($6,664; Ptrend>0.05) and decreased ($6,314 to $6,215) when indexed to the Consumer Price Index for July 2016. Average number of RT fractions per episode decreased from 19.2 in PP1 to 18.6 in PP8; this decrease was most notably seen for breast (-2.1), lung (-2.8), and female genitourinary (-3.5) cancers. Intensity-modulated RT (IMRT) charges accounted for $7.6M (51%) of RT spending and increased 5% from PP1-8, whereas conventional external beam RT made up $3.0M (21%) and decreased 8%. Expenses for image guidance ($2.5M; 17%; +2% from PP1-8) and stereotactic RT ($1.3M; 9%; +1%) increased.
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