In a study reported in JAMA Oncology, Trevor Royce, MS, MD, MPH, and colleagues found that publicly available information on pricing for radiation treatment for prostate cancer was complex and inconsistent, and that pricing varied widely among National Cancer Institute (NCI)-designated cancer centers. As stated by the investigators, a January 2019 price transparency mandate by the U.S. Centers for Medicare and Medicaid Services (CMS) is intended to allow patients to look up the prices of cancer treatment services at hospitals in the United States.

Trevor Royce, MS, MD, MPH

Study Details

The study involved identification of the February 2019 publicly available price-containing chargemasters—a listing of the standard prices for all hospital services and procedures—for 63 NCI-designated cancer centers. The charge per fraction of intensity-modulated radiation therapy used in standard prostate radiation treatment was determined, and the mean charges for a 28-fraction course of prostate irradiation were calculated for all hospitals. Analyses included degree of price variation, association of mean price to the price paid by Medicare, and association of prices with the practice expense geographic practice cost index as determined by Medicare.

Study Findings

Chargemaster information was found to be complex and procedure descriptions inconsistent among hospitals.

Of the 63 hospitals, 52 (84%) listed a price for simple intensity-modulated radiation therapy associated with standard radiation treatment for prostate cancer. For a standard 28-fraction treatment, there was a 22-fold difference between the least expensive and most expensive hospitals, with charges ranging from $18,368 to $399,056. The mean charge was $111,729; this amount was 10.1 times the price ($11,091) that Medicare would pay and exceeded the 100% to 400% of Medicare rates typically paid by private payers. A weak positive association between price and geographic practice cost index was observed (r² = 0.13, P = .008).

The investigators concluded, “The availability of CMS-mandated hospital chargemasters and the descriptors used for simple intensity-modulated radiation therapy are not uniform, and the listed charges are highly variable. The association between listed charges and actual prices paid by patients or insurers is unclear, mitigating the value of the CMS rule for patients with prostate cancer who are receiving radiation therapy. This study suggests that implementation of the CMS price transparency policy may be insufficient to enable patients to estimate or compare prices for prostate cancer radiation treatment.”

Dr. Royce, of the Department of Radiation Oncology at the University of North Carolina at Chapel Hill, is the corresponding author for the JAMA Oncology article.  

Disclosure: For full disclosures of the study authors, visit jamanetwork.com.