Nuclear Medicine Therapy by the Numbers: What is the Real Financial Impact?

Objectives: Therapies are the origins of Nuclear Medicine (NM) and are now seeing a period of growth. From existing therapies such as I-131 and Ra223 to emerging therapies like Lu177-DOTATATE and I-131 MIBG, the cost of such therapies continues to increase. It is unclear whether these rising costs are sustainable or if they will ultimately prevent patients who need the therapy from receiving it. We intend investigate this important question in depth. The purpose of this study is to evaluate the financial impact of current and emerging NM therapies in the current healthcare system and ultimately for the patient.

Methods: This is a retrospective review of the the cost of all therapies offered in division of NM at our hospital, a large academic institution, over the last 5 years. We specifically evaluated the increase in cost versus reimbursement to understand the financial impact to the institution as well as the patient. We also reviewed the re-imbursement variations between insurance companies, any out of pocket expenses for the patient and any unrecovered costs for the hospital.

Results: The cost of therapies has increased significantly over the last 5 years and while they do place an enormous financial burden on the institution and patient, they are still overall financially viable. Our institution has seen as much as a 25% reduction in cost to reimbursement ratio for therapies, which can vary widely amongst Medicare and private payers. The rising costs has furthermore forced the institution to look very closely at cost saving measures to limit the overall financial burden.

Conclusions: Recent advancements in NM therapies are a great step forward for the field and for patients who benefit from these advancements, but the costs are increasing at a high rate. With the ever-increasing costs of healthcare, it is imperative that we control our institutional costs to ensure that we can continue to offer these advanced therapies to patients in the future.