A Medicare cost analysis of MRI- versus CT-based high-dose-rate brachytherapy of the cervix: Can MRI-based planning be less costly? Journal Article


Authors: Bajaj, A; Harmon, G; Weaver, J; Martin, B; Mysz, M.; Surucu, M; Roeske, J. C.; Konski, A. A.; Small, W., Jr; Harkenrider, M. M.
Article Title: A Medicare cost analysis of MRI- versus CT-based high-dose-rate brachytherapy of the cervix: Can MRI-based planning be less costly?
Abstract: PURPOSE: While some institutions deliver multiple fractions per implant for MRI-based planning, it is common for only one fraction to be delivered per implant with CT-based cervical brachytherapy. The purpose of this study was to compare physician costs, hospital costs, and overall costs for cervical cancer patients treated with either CT-based or MRI-based high-dose-rate (HDR) cervical brachytherapy to determine if MRI-based brachytherapy as described can be financially feasible. METHODS AND MATERIALS: We identified 40 consecutive patients treated with curative intent cervical brachytherapy. Twenty patients underwent CT-based HDR brachytherapy with five fractions delivered in five implants on nonconsecutive days in an outpatient setting with the first implant placed with a Smit sleeve under general anesthesia. Twenty patients received MRI-based HDR brachytherapy with four fractions delivered in two implants, each with MRI-based planning, performed 1-2 weeks apart with an overnight hospital admission for each implant. We used Medicare reimbursements to assess physician costs, hospital costs, and overall cost. RESULTS: The median cost of MRI-based brachytherapy was $14,248.75 (interquartile range [IQR]: $13,421.32-$15,539.74), making it less costly than CT-based brachytherapy with conscious sedation (i.e., $18,278.85; IQR: $17,323.13-$19,863.03, p lt; 0.0001) and CT-based brachytherapy with deep sedation induced by an anesthesiologist (i.e., $27,673.44; IQR: $26,935.14-$29,511.16, p lt; 0.0001). CT-based brachytherapy with conscious sedation was more costly than CT-based brachytherapy with deep sedation (p lt; 0.001). CONCLUSIONS: MRI-based brachytherapy using the described treatment course was less costly than both methods of CT-based brachytherapy. Cost does not need to be a barrier for MRI-based cervical brachytherapy, especially when delivering multiple fractions with the same application.
Keywords: cost analysis; Medicare; Cervical cancer; Cervix; Computed tomography-based planning; High-dose-rate brachytherapy; Magnetic resonance imaging-based planning
Journal Title: Brachytherapy
Volume: 17
Issue: 2
ISSN: 1873-1449; 1538-4721
Publisher: Unknown  
Journal Place: United States
Date Published: 2018
Start Page: 326
End Page: 333
Language: eng
DOI/URL:
Notes: LR: 20180302; CI: Published by Elsevier Inc.; JID: 101137600; OTO: NOTNLM; 2017/09/02 00:00 [received]; 2017/11/26 00:00 [revised]; 2017/11/30 00:00 [accepted]; 2018/01/15 06:00 [pubmed]; 2018/01/15 06:00 [medline]; 2018/01/15 06:00 [entrez]; ppublish