Viknesh S. Kasthuri, AB (he/him/his)
Warren Alpert Medical School of Brown University
Disclosure(s): No financial relationships to disclose
National Cancer Institute (NCI)-Designated Cancer Centers (DCC) were identified. NCI-DCC that do not perform patient care or do not participate in Medicare’s Inpatient Prospective System were excluded. In this cross-sectional analysis, commercial negotiated prices were obtained by a search of each center’s website. CPT codes for imaging, catheterization, radiation planning, and brachytherapy radioelements were selected.
Comparison of prices among centers was performed by normalizing the median price for each service at each center to the estimated local 2022 Medicare reimbursement. “Within-center ratio” and “across center ratio” were defined as the ratio between the lowest and highest median commercially negotiated price within a center and across all centers, respectively. All available prices are current as of June 4, 2022.
60.5% (43/71) of NCI-DCC published commercially negotiated rates for any of the CPT codes associated with Y90 treatment. Disclosure varied amongst centers on the procedure level, with anywhere from 3-37 centers disclosing any commercial rates. Codes for individual brachytherapy radioelements had the lowest level of PT. Large variations in pricing both within and across centers were found. Within center ratios ranged from 2.8 to 44.8 and adjusted across center ratios ranged from 9.8 to 173.4.
PT level at NCI-DCC for Y-90 is low. The PT available is limited by heterogeneity in quality and comprehensiveness of disclosures. Some of the minimum and maximum center median values do not seem plausible, and patients do not have the resources to evaluate this critically. PT with respect to the cost of individual Y-90 radioelements is severely lacking and may reflect that negotiation with commercial insurance companies occurs on the procedure level and not on the individual component level. Future improvements in the level and accuracy of PT are needed.