Auditing in radiation therapy – adequacy of current reimbursement methods to evidence-based radiation oncology

Abstract

Radiation therapy is the discipline that uses radiation for the treatment of malignant or benign tumor lesions. Since the 20s, when it was first officially recognized as a medical speciality, an intense development has been seen, as well as an increase in its applicability. Currently, around 60% of all cancer patients will undergo radiotherapy at some point of their treatments. Costs, in oncology, have been growing uninterruptedly for the last years and, radiation therapy, as a branch of this subject, is no exception. The reimbursement system currently adopted in Brazil, known as “fee-for-service”, leads to some distortions and exaggerations at, for example, the number of applied procedures. The radiation dose that is delivered at the target, as well as at surrounding health tissue, should be as low as reasonably achievable. Any excess must be avoided. Otherwise, an increase in adverse events, potentially lethal as second cancers, may be the consequence. The role of the auditing peer-reviewer, in this scenario, is to ensure that patients will receive the best treatment possible, adapting the number of procedures to what is the standard, according to available scientific evidence. The auditing peer-reviewer has also an essential role in assisting the analysis of the literature aiming to validate the adoption of new technologies, if proven to be efficacious, under a proper cost-benefit ratio.