An opportunity to save? SBRT is less costly than IMRT for intermediate-risk prostate cancer.

Introduction and objective: Stereotactic body radiation therapy (SBRT) is a novel form of radiotherapy for prostate cancer which uses ultra-hypofractionated radiation and allows for fewer treatment sessions compared to moderately hypofractionated regimens including intensity-modulated radiation therapy (IMRT). Recent studies have demonstrated comparable oncologic outcomes between SBRT and IMRT for intermediate-risk prostate cancer. We sought to compare the cost of SBRT and IMRT for intermediate-risk prostate cancer.

Methods: We identified men over age 66 diagnosed with intermediate-risk prostate cancer who underwent IMRT or SBRT from 2008 to 2017 using the Surveillance, Epidemiology and End Results-Medicare Linked Database to compare per patient radiation-specific costs. Patients who received a therapeutic regimen, defined as ≥20 fractions of IMRT and ≥2 fractions of SBRT within 90 days, were included. Additionally, only patients treated in 1 locality was included to account for geographic variability in healthcare costs. Linear mixed-effects regression was used to compare per patient costs.

Results: The final cohort included 934 IMRT patients and 237 SBRT patients. Our adjusted model showed the estimated total cost per patient was $20,130 for IMRT and $9,259 for SBRT (P < 0.01). Predictors of higher cost included residing in high-density areas, higher education levels, higher median household income, and earlier years of radiation treatment.

Conclusion: SBRT has significantly lower radiation-specific costs compared to IMRT for intermediate-risk prostate cancer. Our findings support the adoption of SBRT for the treatment of localized prostate cancer to lower healthcare costs while maintaining quality prostate cancer care.