Adoption of Radiation Technology Among Privately Insured Nonelderly Patients With Cancer in the United States, 2008 to 2014: A Claims-Based Analysis

Despite enthusiasm for advanced radiation technologies, understanding of their adoption in recent years is limited. The aim of this study was to elucidate utilization trends of conventional radiation, intensity-modulated radiotherapy (IMRT), brachytherapy, proton radiotherapy, stereotactic body radiotherapy (SBRT), and stereotactic radiosurgery (SRS) using a large convenience sample of irradiated patients with cancer identified from private insurance claims in the United States. The unit of analysis was a claim corresponding to a fraction of delivered radiotherapy from 2008 to 2014. Each claim was assigned a disease site on the basis of the diagnosis code and a radiation technology on the basis of the procedure code. In 2014, conventional radiation and IMRT constituted 56% and 39% of all radiation treatment claims, respectively, while brachytherapy constituted 2%, proton radiotherapy 1%, SBRT 1%, and SRS <1%. Compared with the first quarter of 2008, the proportional contribution of conventional radiation and brachytherapy to all radiation claims each decreased by 16% in the fourth quarter of 2014. In contrast, proportional contribution increased by 32% for IMRT, 83% for proton radiotherapy, 124% for SRS, and 309% for SBRT. Prostate cancer constituted 60% of all proton claims in 2008 but declined to 37% by 2014. SBRT was used to treat a variety of disease sites, most commonly primary lung (25%), prostate (12%), secondary bone (9%), and secondary lung (9%), in 2014. In this claims-based analysis of younger patients with private insurance, conventional radiation and IMRT were the most commonly used technologies from 2008 to 2014, while SBRT showed the most robust growth over the study period.