Cost of palliative external beam radiotherapy (EBRT) use for bone metastases secondary to prostate cancer

Background Evaluations of the costs of palliative external beam radiation therapy (EBRT) for treatment of bone metastases are limited. Objective To summarize EBRT lifetime care patterns in deceased men with metastatic prostate cancer treated in a cancer hospital in the United States. Methods A retrospective review of electronic health records identified deceased adult prostate cancer (ICD-9 185. xx) patients with bone metastases (ICD-9 198.5) and who were treated for bone pain and metastasis management with EBRT between January 1, 1995 and December 17, 2012. Common Procedural Terminology codes were used to identify all EBRT episodes (total billed EBRT services; initial and final evaluation) to calculate length of EBRT treatments and per episode costs (2011 US$). Bootstrapping approximated the 95% confidence interval for final cost estimates. Results 176 men were identified; 19 (10.8%) had bone metastases in > 1 site. Eighty-nine men (50.6%) received > 1 EBRT episode (range, 1-6; median, 2), with first episode length ranging from 1-44 calendar days (mean, 13.4; SD, 8.4) at a mean cost of $7,084 (SD, $4,028). About 70% of costs were attributable to hospital charges and 30% to physician charges. Limitations Small sample size limits broad applicability to large populations of men with prostate cancer. Conclusion Care costs for EBRT constitute one of many costs that should be taken into account when planning for palliative care of prostate cancer and bone metastasis.