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TOPLINE:

Patients enrolled in Medicare Advantage received fewer advanced radiotherapy techniques, such as proton treatment and stereotactic radiotherapy, but had greater estimated costs and longer average treatment durations than those with traditional Medicare.

METHODOLOGY:

• Enrollment in Medicare Advantage has increased substantially among older adults in the United States, but it’s unclear how efficient and high-quality the care is compared with traditional Medicare.
• Researchers conducted a retrospective cross-sectional analysis of 2018 Medicare claims data for patients with traditional Medicare or Medicare Advantage aged 65 years or older who were receiving radiotherapy for 15 cancer types to compare the type of radiotherapy, length of treatment, and spending per 90-day episode for each type of coverage.
• The analysis included 31,563 treatment episodes among 30,941 patients. Overall, 22,594 episodes (71.58%) were covered by traditional Medicare, and 8969 episodes (28.42%) were covered by Medicare Advantage.
• Investigators examined the primary type of radiotherapy technology used, treatment length, and estimated spending for 90-day radiotherapy episodes, adjusting for cancer type, age, dual-eligibility status, and medical comorbidities.
• Treatment length was defined as the total number of radiotherapy visits, regardless of technology, per 90-day episode.

TAKEAWAY:

• When comparing treatment episodes, researchers found that patients with Medicare Advantage were significantly less likely to receive proton therapy (0.58% vs 1.65%; odds ratio [OR], 0.36) or stereotactic radiotherapy (13.77% vs 15.01%; OR, 0.87) but more likely to receive two- or three-dimensional radiotherapy (44.17% vs 42.43%; OR, 1.13) than those with traditional Medicare.
• Mean treatment length was significantly greater under Medicare Advantage than under traditional Medicare, with an average of 21.38 treatments under Medicare Advantage vs 19.48 treatments with traditional Medicare. Treatment length was longer for each individual radiotherapy modality as well.
• Overall, estimated spending on radiotherapy episodes was about $2800 higher with Medicare Advantage than traditional Medicare — $8677.56 vs $8393.20 (relative risk, 1.04). Spending per episode was higher for each individual radiotherapy modality as well.

IN PRACTICE:

“We found that for Medicare Advantage radiotherapy episodes, there was higher estimated spending and greater mean treatment length than for traditional Medicare radiotherapy episodes. Although among Medicare Advantage episodes, there was lower utilization of more expensive, advanced treatment modalities, Medicare Advantage was not associated with cost savings compared with traditional Medicare,” the study authors wrote.

SOURCE:

The study, led by Jacob Hogan, MD, Harvard Radiation Oncology Residency Program in Boston, was published in JAMA Network Open.

LIMITATIONS:

Due to unavailable Medicare Advantage reimbursement data, researchers standardized Medicare Advantage spending using the traditional Medicare Physician Fee Schedule. The study focused solely on radiotherapy spending rather than overall patient spending to ensure methodological clarity. Additionally, claims data lacked granular clinical information such as time from diagnosis to radiotherapy initiation and insurance approval rates for radiation therapy. Differences in data reliability between Medicare Advantage plans presented another limitation, though results remained consistent when including all Medicare Advantage plans. 

DISCLOSURES:

This study was supported by grant KO8CA273549 from the National Cancer Institute (NCI). Alexander Spektor, MD, PhD, disclosed receiving grants from NCI and Burroughs Wellcome Fund outside the submitted work. Thomas C. Tsai, MD, MPH, reported receiving grants from Arnold Ventures during the conduct of the study and support from Harvard Catalyst.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.