Financial toxicity is a damaging consequence of oncologic therapy addressable through improved price transparency. The US government recently mandated that hospitals publish a “chargemaster,” or list of “standard charges” for provided services. Patients often travel to tertiary centers for intracranial stereotactic radiotherapy (SRT), but cost comparison is complicated by multiple delivery systems and fractionation schemes. We hypothesized that publicly listed prices vary widely between comparable SRT modalities and by institution.
Through online query, we obtained chargemasters for clinical National Cancer Institute (NCI)-designated centers. Technical charges for Gamma Knife (GK), single fraction linear-accelerator stereotactic radiosurgery (SRS), and 3-fraction fractionated stereotactic radiation therapy (FSRT) were obtained by billing code and keyword searches. Prices were adjusted by the Medicare geographic cost price index (GPCI). Pairwise comparisons were conducted to compare prices between modalities and geographic regions. Price association between modalities and relationships with cost index were examined using Spearman correlations.
62 chargemasters were obtained, and 58 listed SRT prices. Median prices varied widely (GK-$49,529; FSRT-$31,834; SRS-$22,915) with large interquartile ranges. Adjusting for GPCI, GK (p = .0003) and FSRT (p = .001) were significantly more expensive than SRS, and no difference in price was noted between regions. FSRT price was positively correlated with GPCI (p = .033) but other modalities were not. Modality prices were positively correlated (all p < .001).
Published prices for SRT vary by delivery system, fractionation, and by institution. Differences are poorly explained by variable cost of living. These inefficiencies expose patients already at high risk for financial toxicity to unnecessary costs.