2640 - Modeling of Out-Of-Pocket Costs Across Medicaid and Medicare Plans of Standard-of-Care Radiosurgery Duration for Metastatic Spine Cancer

V. S. Wu¹, M. Khlopin², and S. McClelland III³; ¹University Hospitals Seidman Cancer Center, Case Western Reserve University, Department of Radiation Oncology, Cleveland, OH, ²University Hospitals Cleveland Medical Center Department of Radiation Oncology, Cleveland, OH, ³Case Western Department of Radiation Oncology, Cleveland, OH

Purpose/Objective(s): Spine radiosurgery/stereotactic body radiation therapy (SBRT) for metastatic disease is defined by United States billing as treatment ranging from 1-5 fractions. The out-of-pocket (OOP) costs that patients face under this radiation modality and fractionation methods is understudied. Our study aims to evaluate expenses across three public insurance plans, aiming to enhance comprehension and transparency regarding treatment costs. Materials/Methods: We relied on the recommendations outlined in the National Comprehensive Cancer Network (NCCN) guidelines and the insights of experts to define the standard treatment protocol for managing symptomatic metastatic spine cancer. Out-of-pocket (OOP) costs were determined by combining annual deductibles, treatment expenditures, and copayments across three public insurance plans: Original Medicare, Medigap Plan G, and Medicaid. The calculations spanned a two-year timeframe (without adjustments for inflation), with the assumption that all treatments and evaluations occurred at a hospital in Ohio.

Results: RT-specific treatment charges include on-treatment radiation oncologist visits, treatment planning, simulation and verification, RT delivery, on-treatment visits, and follow-up visits. Under Original Medicare plans, beneficiaries are faced with an OOP cost of 20% of the approved claims charges after the annual $240 deductible is met. For Spine SBRT, Medicare beneficiaries are faced with an OOP cost of $1,127.03, $1,444.92, $1,762.82, $2,080.71, and $2,398.60 after two years for one-, two-, three-, four-, and five-fractions of SBRT, respectively. Medigap Part G beneficiaries are faced with a total OOP charge after two years of $480 for all SBRT fractionations. Under Medicaid insurance, beneficiaries are faced with no OOP expenses with no limitations.

Conclusion: In spine SBRT, single-fraction is the least financially toxic regimen with regard to OOP costs under Medicare at two-years post-treatment, while five-fraction is the most toxic – 113% more than single-fraction, 66% more than two-fraction, and 36% more than three-fraction. Even the commonly utilized three-fraction regimen is 56% and 22% more toxic than single and two-fraction regimens. Finally, for the only regimen supported by Level 1 evidence (two-fraction; PMID 34126044), reduction to one fraction reduces toxicity by 28% at two-years post-treatment. These findings provide further support that minimizing spine SBRT fractionation (when safely and efficaciously achievable) provides the best chance of optimizing patient quality of life.