Regional Variations in Medicare Coverage

Today's New York Times has a well-reported article on Medicare coverage Cyber-knife treatment of prostate cancer.  This is covered in 33 states and not in 17 (and you can generally tell by whether or not there is an onslaught of radio ads for this technology).  Cyberknife allows more focused radiation therapy, and has been well-demonstrated to be advantageous for brain and spinal tumors.   However, the manufacturer is pushing this therapy for more common cancers, including lung and especially prostate.   There is a substantial patient advantage -- fewer  trips for radiation therapy.   There is also a substantial provider advantage. The machines to deliver this are very expensive ($3-5 million), so being able to use these machines for more common diseases can create a lot of marginal profit.  While the Times reports that Cyberknife is less expensive than some other radiation therapy, that doesn't necessarily mean that coverage will be cost saving, as the smaller number of required treatments might encourage some men to get treatment who would have otherwise opted for watchful waiting.   

The Times reports that there are five year outcome studies for a total of only 80 patients.