But not antiquated reimbursement structures. A NCDB analysis demonstrates a steady decline in use of conventional fractionation (i.e., >30 fractions) for definitive prostate radiation from 76% of cases in 2004 to 37% in 2020. At the same time, use of moderate hypofractionation (20-30 fractions) increased from 22% to 45% and ultra-hypofractionation (≤7 fractions) from 2% to 18%. In fact, by 2020, the majority of radiation courses for low-risk disease were ultra-hypofractionated, though notably the number of men receiving radiation for low-risk disease steadily declined throughout this period and represented only 7% of cases in 2020. “Discussion of financial incentives is relevant as reductions in radiation reimbursement continue despite radiation objectively providing value to the health system and patients and despite radiation representing a small component of annual cancer spending.” | Yu, JAMA Oncol 2023
