Cost of Treatment for Brain Metastases Using Data from a National Health Insurance Provider

Background Brain metastases affect 10-20% of US cancer patients, presenting a significant healthcare challenge and necessitating intricate, high-cost treatments. Few studies have explored the comprehensive care cost for brain metastases, and none have used real insurance claims data. Partnering with a northeastern healthcare insurer, we investigated the true costs of various brain-directed radiation methods, aiming to shed light on treatment expenses, modalities, and their efficacy. Methods We analyzed medical claims from XXXXX-insured patients in PA, DE, WV, and NY diagnosed with brain metastases (ICD-10 code C79.31) and treated with radiation from 01/01/2020 to 07/01/2022. Costs for radiation techniques were grouped by specific CPT claim codes. We subdivided costs into technical and physician components and separated hospital from freestanding costs for some modalities. Results From 01/01/2020 to 07/01/2022, 1,048 XXXXX members underwent treatment for brain metastases. Females (n=592) significantly outnumbered males (n=456), with an average age of 64.4 years. Each member had, on average, 5.309 claims costing $2,015 per claim. Total cost totaled $10,697,749. Per-treatment analysis showed that Hippocampal Avoidance-Intensity Modulated Radiotherapy (HA-IMRT) was the costliest treatment at $47,748, followed by stereotactic radiotherapy (SRT) at $37,230, Linear Accelerator Stereotactic Radiosurgery (LINAC SRS) at $30,737, Gamma Knife (GK) SRS at $30,711, and Whole-Brain Radiation Therapy (WBRT) at $5,225. Conclusion WBRT was the least costly radiation technique. Similar per-treatment prices for GK and LINAC SRS support their use in treating brain metastases. SRT in general was costlier on a per-use basis than SRS, prompting further scrutiny on its frequent use. HA-IMRT was the costliest radiation therapy on a per-use basis by a moderate amount, prompting further discussion about its comparative cost-effectiveness against other radiation modalities. This study underscores the importance of multiple considerations in treating brain metastases, such as tumor control, survival, side effects, and costs.