Comparative Cost Modeling of Out-of-Pocket Costs for External Beam Radiation Therapy Versus Stereotactic Body Radiation Therapy in Metastatic Spine Cancer.

purposeThe choice between stereotactic body radiation therapy (SBRT) and external beam radiation therapy (EBRT) for spine metastases depends on several factors: tumor size, tumor location, patient health, prognosis, other treatments (i.e., surgery, minimally invasive procedures, systemic therapy, and supportive care), and treatment goals. Limited evidence exists on insurance's influence on out-of-pocket (OOP) expenses across radiation modalities. This study assesses costs across various insurance plans, including original Medicare and Medicaid. METHODS AND MATERIALS: National Comprehensive Cancer Network (NCCN) treatment guidelines for symptomatic metastatic spine cancer were used. OOP costs (not adjusted for inflation) were calculated using deductibles, treatment costs, and copays across three public insurance plans-Original Medicare, Medigap Plan G, and Medicaid-over a two-year period for treatments provided in an Ohio hospital. EBRT was defined as one fraction (8 Gray (Gy) x 1), five fractions (4 Gy x 5), or ten fractions (3 Gy x 10). SBRT was defined as one fraction (16-24 Gy x 1), two fractions (24 Gy x 2), three fractions (24-30 Gy x3), four fractions (26-32 Gy x 4), and five fractions (30-40 Gy x5).

resultsMedicare beneficiaries with Original Medicare face OOP costs: $807.01, $871.51, and $961.09 for EBRT one fraction, five fractions, and ten fractions, respectively, after two years. Medicare beneficiaries face charges: $1,127.03, $1,444.92, $1,762.82, $2,398.60, and $2,398.60 for SBRT 1, 2, 3, 4, and 5 fractions, respectively. Under Medigap Part G, patients are responsible only for the annual deductible of $240 (2024), facing a total charge of $480 after two years, regardless of radiation modality and fractionation. Medicaid beneficiaries face no OOP expenses as all expenses are covered with no cap, regardless of treatment option. Under Original Medicare plans, beneficiaries face an OOP cost of 20% (for treatment covered under Part B) of the approved claims charges after the annual $240 deductible is met.

conclusionsSBRT has higher out-of-pocket costs than EBRT for metastatic spine cancer, depending on the fractionation schedule. These findings highlight the need for strategies to reduce financial toxicity in cancer care.