2117 - An Analysis of the Distribution and Density of Rectal Spacer Implanters for Men Receiving Prostate Radiotherapy across the United States

S. A. Patel¹, N. Odiah², and K. Morris²; ¹Department of Radiation Oncology, Emory University, Atlanta, GA, ²Boston Scientific, Marlborough, MA

Purpose/Objective(s): Rectal spacers with prostate radiotherapy (RT) reduces acute and late bowel toxicity. Widespread use of this procedure is limited, perhaps in part due to provider training. Exploring the provider landscape of rectal spacer use for men undergoing prostate RT across the United States (US) is crucial to identify potential disparities in physician training and/or patient access to this toxicity-sparing procedure. Herein, we investigate the number and distribution of physicians performing rectal spacer procedures for prostate RT at the state and facility level across the US in 2021 and 2022. Materials/

Methods: Billing claims from medical clearinghouse data obtained from Definitive Healthcare (DHC) from January 2021 to December 2022 was used to identify all US healthcare providers performing rectal spacer procedures (CPT 55874) = 90 days of prostate RT initiation. The datasets included commercial, Medicare Advantage, Medicaid, Veterans Affairs (VA), and Medicare Fee-For-Service (FFS) claims. Physician specialty and primary facility type (academic versus community) was queried. During 2021-2022, unique number of physicians performing the procedure relative to total new prostate RT cases was calculated within each state.
Results: During 2021-2022, a total of 3,066 US physicians performed at least one rectal spacer procedure. Amongst these users, 59% were urologists, 31% were radiation oncologists, and 1% were interventional radiologist. 27% of implanters practiced at an academic facility. Only 3% of rectal spacer users accounted for 31% of all rectal spacing procedures conducted during this time period. The 10 states with the highest number of physicians performing these procedures (CA, NY, VA, OH, PA, FL, TX, MI, IL, GA) comprised 56% of all rectal spacer users nationwide and performed 55% of the total cases. The 5 states with the lowest number of physicians performing rectal spacer procedures (HI, VT, AK, RI, ME) contributed only 1% of the total cases. Nebraska (NE) had the highest density of rectal spacer use, with 3.37 implanters per 100 prostate RT cases. Maine (ME) had the lowest density of rectal spacer use, with 0.19 implanters per 100 prostate RT cases.
Conclusion: We observed a wide variation of number and density of rectal spacer users across the US. While there is a high density of rectal spacer users in a small group of states, prostate cancer patients residing in many states have restricted access to this toxicity-sparing procedure. Future analyses evaluating provider-specific (e.g. age, specialty, prostate cancer case volume) and facility-specific characteristics (e.g. academic/training versus community), as well as the variability in state-level coverage/payments, impacting these disparities is underway.