How much does GK or CK really cost?

[Nannybee]

The physician charges were actually a minimal part of the charges. $2100 for the neurosurgeon, $3500 for the radiation oncologist, $380 for the radiologist. The biggest charges were for the actual use of the machine. I had LINAC treatment with 4 passes and each pass was broken down on the bill and averaged $14500 per pass. The charge for use of the head frame itself was also on the bill.

[robinb]

Just as a PS to my previous posts on this topic:

The billing dept at UPMC continued to try and squeeze more from my insurer. When they were finished, I questioned a couple of charges and those were taken off. So my final out of pocket costs for the GK procedure was $1,991.52 plus $60 for office visit consult copay and $10 for lab tests.

My ongoing MRI's are covered at 100% as well.

All in all, I am very lucky that I have good insurance.

[PaulW]

"I had LINAC treatment with 4 passes and each pass was broken down on the bill and averaged $14500 per pass."

This is a very important point.....

Does fractionation actually work?
Its a very good question!

Real world results between GK and other fractionated treatments are almost identical. Why?

In many countries single session LINAC radiosurgery is common place,
Why is the practice of multiple sessions so popular in the US? But not elsewhere?

There are a lot of people charging 3-5 times more for a procedure that may provide advantages.
The actual proof that fractionation provides better outcomes than single session remain thin.

Because fractionation "might" be helpful many keep doing it and charging appropriately

 

[Nannybee]

Paul, My LINAC treatment was not fractionated. The Trilogy machine has the ability to do both SRS and FRS. I had SRS, but unlike GK, the machine moves around the patient in an arc with each arc considered a pass in my billing example. I had a single treatment where the machine made 4 passes around me.

[PaulW]

Cool Got it... Single fraction, 4 arcs.
The prices in the US are a lot more than here in Australia.
We pay about $15500 for the entire treatment.
I shudder to think what a fractionated cost would be for 5 fractions.
I guess my concern is that we are sold on the idea of fractionation which allows operators to charge 3-5 times versus a single fraction. It is still unclear as to whether fractionation provides superior results to single fraction.


Approximate prices in US Dollars inclusive of 10% gst in Australia
Which tourists can claim back.

All inclusive prices excluding cost of CT or MRI
GK is US$ 22500
Trilogy around $15500 for 4-6 arcs
Varian Linac SRS $5000 for 6 arcs

MRI's on older machines are down to $350
MRI's on the latest machines around $900

One wonders if there was a bit more "medical tourism" if that would help drive competition and reduce prices in the US

[arizonajack]

Real world results between GK and other fractionated treatments are almost identical. Why?

Same reason some people buy Fords and others buy Chevys.

They are both boxes on wheels with all of the same equipment and similar in quality and performance.

There are other analogies.

Houses, for example. Some people like brick. Some people like stucco. They serve the same purpose. Houses are boxes in which you keep your stuff. (Thank you, George Carlin.)

Food. Sushi vs cheeseburger. Both serve the same purpose and are indistinguishable when they come out the other end.

Bear with me. Only one more.

Mac vs PC.

It's a matter of perception

[Jim Scott]

It's a matter of perception.

Well yes, but doctor recommendations often are determinate.  AN patients are not always knowldgable about the various attributes or risks of radiation options and some doctors prefer GK to CK and vice versa, usually based on their experience. 

Jim

[nftwoed]

Hello;

   Perhaps a desire for a market share? The comparison between the two radiation forms have not always been quite so close, have they?

[nftwoed]

Hello;

   I'm not so sure it's as simple as a 'single fraction." The tumor actually receives several hits in GK, I believe.

[phantagrae]

While I don't really know anything about GK vs CK vs SRS vs FSR, I don't think that my doctor is trying to scam me by offering me fractionated treatments.

Maybe I'm naive, but I think that the 30 treatments I've had have been pretty easy on my body, compared to the accounts I've heard from some people about the side-effects of single session GK.

I had the option to do 5 treatments or 30.  The doctors I spoke with, knowing I was a musician and that hearing preservation was my main goal, felt that the lower individual doses with FSR would be the best way to go easy on my hearing.
And I don't know that it's about making more money, since the clinic I'm going to is a non-profit facility, often writing off the entire cost of treatment in some cases.  I don't know how much assistance I'll receive, but they know that my puny insurance will not pay for any of my treatment.

In my treatments, I think I get "zapped" about 10 or 11 times each time--the machine rotates around, and the angle of the bed is changed a couple of times as it aims at my head from different angles.

I have only 3 more to go!!

[terisandler]

I had 5 CK treatments and each time I went the CK machine made multiple passes to the tune of a total bill of approximately $85k.  The EOB showed multiple charges for each of the 5 days I went - apparently one for each pass.

[mk]

The physician charges were actually a minimal part of the charges. $2100 for the neurosurgeon, $3500 for the radiation oncologist, $380 for the radiologist. The biggest charges were for the actual use of the machine. I had LINAC treatment with 4 passes and each pass was broken down on the bill and averaged $14500 per pass. The charge for use of the head frame itself was also on the bill.

Back to the original discussion, I was able to obtain the actual breakdown for the GK costs here in Ontario, Canada that are charged to our health plan (which is run by the province):

Gamma knife treatment day $2,121.16 includes MRI with Gadolium, CT Scan, Treatment planning and Gamma Knife treatment.  Total AN related costs $5,250.60 includes all diagnosis related testing, including audiology and MRI's. Follow up MRI's, surgery and radiology consultation over a two year period and the treatment day itself.

Assuming that physician costs in N. America would be (relatively) comparable, it seems that the major difference is the cost for using the equipment. I suspect that the reason why costs for equipment usage in the States is so high, as everyone mentioned, is that the cost for capital cost recovery is factored in. i.e. different models for calculating the cost: In the States someone (a hospital, or clinic for example) makes the initial investment and pays for the capital cost for installation/initial commissioning etc., and then this cost is recovered through the span of many years, from the users.
In the other model, the cost is covered upfront (by taxpayers money), so there is no need to factor in the cost for capital cost recovery into the actual treatment. Plus the state-run health insurance plans can put a cap on what they pay for usage.
Recognizing that capital cost for such equipment must  be covered, it is then a matter of paying upfront (by the taxpayers), vs. paying afterwards (by the users).

I don't want to stir any discussion about which model is better; the point is that cost must be recovered somehow, and there are different models for doing this. I am just trying to find an explanation for the big differences reported.

Marianna

[arizonajack]

Hello;

   I'm not so sure it's as simple as a 'single fraction." The tumor actually receives several hits in GK, I believe.

You're right.

It's a single session.

But the radiation is applied to the tumor in a series of "shots" aimed at different sections of the tumor so that the combined number of "shots" covers the entire tumor. The number and position of the "shots" depend on the size and shape of the tumor