Medicare payments for the treatment of prostate cancer using CyberKnife radiosurgery vary widely by geography, according to an article published by the New York Times on December 17. Men in a number of U.S. states have no Medicare coverage for CyberKnife treatments, according to the article.
Medicare recipients who live in 33 states have insurance coverage for CyberKnife treatments, but men who live in 17 states are out of luck. In those states, which include California and Texas, Medicare coverage and payment is limited to conventional radiation therapy treatment programs.
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The geographic disparity is a result of three of the 15 regional Medicare contractors classifying CyberKnife treatment as experimental, stating that there is not enough evidence of its long-term effectiveness against prostate cancer, according to the article by reporter Stephanie Saul. The three Medicare contractors are Noridian Administrative Services of Fargo, ND; Palmetto GBA of Columbia, SC; and TrailBlazer Health Enterprises of Dallas.
The CyberKnife system from Accuray of Sunnyvale, CA, is a frameless robotic radiosurgery system that uses real-time tracking capabilities to deliver high doses of radiation at submillimeter precision, even during patient respiration. It is predominantly being used to treat tumors of the spine, lung, pancreas, and prostate.
To date, more than 50,000 patients worldwide have received CyberKnife treatment, according to statistics provided to Accuray by its customers. Use for prostate cancer treatment increased by 95% between July 2007 and June 2008, according to Accuray, and continues to escalate. The primary appeal of the technology to patients with prostate cancer is its five-day treatment duration, compared to an eight-week regimen of conventional radiation therapy.
The system's cost may also be lower. The average cost to Medicare for CyberKnife prostate cancer treatment is $29,000, Saul reported. But it may be less expensive than or comparable to other radiation treatment methods, which can cost as much as $50,000. An estimated 219,000 men are expected to be diagnosed with prostate cancer in 2009, more than 50% of whom will be age 65 or older.
Medicare has been the subject of criticism and complaints about its inconsistent policies relating to reimbursement of new technologies. Since 1965, when the U.S. Congress allowed for regional autonomy in reimbursements, Medicare has resolved approximately 300 inconsistencies relating to new treatments and use of new technologies. However, a national coverage decision about CyberKnife is not currently in the works, Saul reported Medicare spokesman Donald McLeod as saying.
CyberKnife received U.S. Food and Drug Administration (FDA) 510(k) clearance in 1999 for treatment of brain and spine tumors, and clearance was extended to other parts of the body in 2001. Critics have argued that not enough time has elapsed to evaluate long-term patient outcomes, and that published peer review literature has followed only 80 patients who received the treatment for prostate cancer.
The American Society for Therapeutic Radiology and Oncology (ASTRO) has called the CyberKnife system promising, but the organization has questions about the data used to support its role in prostate cancer treatment, Saul wrote.
By Cynthia Keen
AuntMinnie.com staff writer
December 23, 2008
Related Reading
Faster respiratory motion prediction aids radiotherapy, October 10, 2008
Headgear: Is radiosurgery the right treatment for trigeminal neuralgia? December 31, 2007
Imaging adds precision as IGRT sweeps radiation oncology, October 20, 2006
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