Medicare claims for a high-tech form of radiation therapy to treat breast cancer that's twice as expensive as simpler techniques increased tenfold in recent years, helping to drive up the average cost of breast radiation by 33 percent, according to a new study by M.D. Anderson researchers.

The jump in billing for the technique, intensity-modulated radiation therapy, could be driven in part by reimbursement policy, the researchers argue in the study, released Friday in the Journal of the National Cancer Institute.

They also suggest that local Medicare policy has a big effect on use of the technology.

IMRT uses 3-D treatment planning and dynamic multileaf collimators to shape the radiation beam to deliver a more even dose to the tumor and a smaller dose to surrounding, healthy tissue, such as the skin, the other breast and possibly the heart.

The authors, led by Dr. Benjamin D. Smith, a radiation oncologist with M.D. Anderson in Houston, believe that the growth of the procedure in recent years comes in part from patients getting drawn to the technology because of clinical evidence that it can reduce skin injuries, lower toxicity to healthy tissue and improve cosmetic outcomes.

But they also believe higher payments might have helped. According to the researchers, the mean cost for non-IMRT radiation treatments is $7,179; for IMRT, it's $15,230.

To study the growth of IMRT, the researchers examined a huge Medicare records source, the Surveillance, Epidemiology and End Results, or SEER database, where they examined records of 26,163 women 66 years or older with non-metastatic breast cancer, who were treated with surgery and radiotherapy between 2001 and 2005.

They found that IMRT billing jumped tenfold in the study period, moving from less than 1 percent of patients diagnosed in 2001 to over 11 percent in 2005. The resulting adoption was linked to the increase in the mean cost of breast radiation, which grew from $6,334 in 2001 to $8,473 in 2005.

Interestingly, local coverage determination by Medicare also influenced adoption, with regions with more favorably disposed Medicare Carriers seeing higher IMRT billing rates. However, less favorable regions saw 28 percent lower radiation therapy and total health care costs for the women within one year of diagnosis.

They also discovered that IMRT billing was 36 percent higher for patients treated in freestanding centers than in hospital-based clinics.

In the authors' view, this shows that under Medicare's current structure, some regions concentrate on controlling cost, such as those with less favorable IMRT stances, while others look to give patients the most advanced care, such as those with favorable IMRT billing practices.

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