Evaluation of Trends in Use of IMRT in Head and Neck Cancer

ObjectiveEvaluate the trends of use of IMRT for head and neck cancer (HNC), with emphasis on Medicare reimbursement patterns and their effect on clinical use.MethodAll patients are selected from the Surveillance, Epidemiology, and End Results (SEER) database with HNC who were treated with radiation. These were then subdivided into those that were treated with IMRT. We then analyzed Medicare records for reimbursement patterns for Planning and Delivery of IMRT (CPT Codes 77301 and 77418).ResultsRegression analysis was then performed on the SEER data to evaluate cancer subsites, regional differences, and outcomes. Reimbursement for IMRT for Head and Neck cancer has increased since the introduction of CPT codes for Medicare from $1579 to $2643 from 2002 to 2010. In 2000 Medicare reimbursement for IMRT was 4x that of conventional radiation. This has more recently been adjusted to 3x conventional radiation. Compensation has been cited as a major factor in the adoption of this technology. The percentage of patients receiving IMRT vs traditional radiation has increased substantially from 3% in 2001 to 46% in 2005.ConclusionAdvantages of IMRT include decreased xerostomia and improved quality‐of‐life. No reports have demonstrated improved local‐regional control/survival. We show recent Medicare adjustments have not had a significant change in utilization of IMRT. This study raises questions about the role of economic incentives potentially driving IMRT usage.