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The Case for Prostate Brachytherapy in the Affordable Care Act Era

      Few oncologic entities are more deserving of national scrutiny than low-risk prostate cancer. Prostate cancer is among the top 5 most costly cancers, with $11.9 billion spent annually in the United States (
      • Mariotto A.B.
      • Yabroff K.R.
      • Shao Y.
      • et al.
      Projections of the cost of cancer care in the United States: 2010-2020.
      ). Recent publications have drawn attention to financially driven practices and questionable referral patterns (
      • Mitchell J.M.
      Urologists' use of intensity-modulated radiation therapy for prostate cancer.
      ,
      • Elliott S.P.
      • Jarosek S.L.
      • Wilt T.J.
      • et al.
      Reduction in physician reimbursement and use of hormone therapy in prostate cancer.
      ). The Congressional Budget Office estimates that half the increase in health care expenditures over the past decades has been driven by expanded capabilities associated with new technologies (
      • Congressional Budget Office
      Technological change and the growth of health care spending.
      ). Intensity modulated radiation therapy (IMRT) and proton therapy come to mind. IMRT now accounts for more than 80% of radiation therapy treatments (
      • Nguyen P.L.
      • Gu X.
      • Lipsitz S.R.
      • et al.
      Cost implications of the rapid adoption of newer technologies for treating prostate cancer.
      ). Brachytherapy, by contrast, has been steadily declining in the United States (

      Elliott SP, Jarosek SL, Virnig BA. Changes across time and geography in the use of prostate radiation technologies for newly diagnosed older cancer patients. Types of prostate radiation. Data Points # 16 (prepared by the University of Minnesota DEcIDE Center, under Contract No. HHSA29020100013I ). Rockville, MD: Agency for Healthcare Research and Quality; November 2012. AHRQ Publication No. 12-EHC095-EF.

      ). Payors are taking notice. Blue Shield of California and Aetna have stopped covering proton therapy for prostate cancer. Government and privately administered health insurers cut costs by reimbursing IMRT at a fraction of the billable rate. Treating institutions respond by inflating rates to compensate for aggressive cuts.
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      References

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        • Congressional Budget Office
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        • Gu X.
        • Lipsitz S.R.
        • et al.
        Cost implications of the rapid adoption of newer technologies for treating prostate cancer.
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      1. Elliott SP, Jarosek SL, Virnig BA. Changes across time and geography in the use of prostate radiation technologies for newly diagnosed older cancer patients. Types of prostate radiation. Data Points # 16 (prepared by the University of Minnesota DEcIDE Center, under Contract No. HHSA29020100013I ). Rockville, MD: Agency for Healthcare Research and Quality; November 2012. AHRQ Publication No. 12-EHC095-EF.

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      2. Congressional Budget Office. Updated estimates of the effects of the insurance coverage provisions of the Affordable Care Act, April 2014: http://www.cbo.gov/publication/45231. Accessed December 24, 2013.

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