Impact of intensity-modulated radiotherapy on health care costs of patients with anal squamous cell carcinoma

Abstract

Purpose Drivers of variation in the cost of care after chemoradiotherapy for the management of anal squamous cell carcinoma (SCC) have not been fully elucidated. We sought to characterize the direct and indirect impact of radiotherapy modality on health care costs among patients with anal SCC. Patients and Methods Aretrospective cohort study was performed using the 2014 linkage of the SEER-Medicare database. We identified 1, 025 patients with anal SCC diagnosed between 2001 and 2011 and treated with chemoradiotherapy. Propensity score matching was used to balance baseline differences between patients treated with intensity-modulated radiotherapy (IMRT) and those treated with three-dimensional conformal radiotherapy (3D-CRT). Differences in total, cancer-attributable, and procedure-specific costs between groups were measured. Results Radiation-related, patient out-of-pocket, and total costs in the 1-year period after radiotherapy startwereall higher for theIMRTgroup than the3D-CRTgroup (median total cost, $35, 890 v $27, 262, respectively; P