Comparison of survival outcomes after CyberKnife (R) radiotherapy in Taiwan using preapproved insurance-based reimbursement versus out-of-pocket expenditure

Background: With technological advances, radiotherapy has progressed from simple irradiation to robotic arm-based stereotactic radiosurgery systems (SRS, in this case, CyberKnife (R)). This equipment is high-priced and might be cost-effective or not. The National Health Insurance (NHI) in Taiwan has a premedical claims review process for approving CyberKnife (R) treatment; however, patients might have to pay for the procedure themselves if the NHI rejects the practice. Under the high treatment cost and such an insurance system, a sketch of patients treated by these high-cost machines and whether the prereview of insurance for reimbursement is reasonable without hindering the patient's right to undergo treatment should be investigated. In this study, the patients of CyberKnife (R) radiotherapy in our institute were investigated as an example for this purpose. Methods: Patients who underwent CyberKnife (R) radiotherapy in our department were investigated retrospectively. Their demographic characteristics, disease patterns, and treatment sites were analyzed. Survivals were compared according to clinical features, and treatment expenses were reimbursed after prereview or out-of-pocket. Results: From October 19, 2014, to January 30, 2018, there were 331 patients included in this study, 205 (55.3%) of whom underwent CyberKnife (R) radiotherapy at their own expense, while 166 (44.7%) had their expenses approved for reimbursement after prereview by NHI. Most patients were treated for metastatic tumors (37.5%), and the brain was the most frequent treatment site (46.1%). The 1-year overall survival was 67.1%, and the 2-year overall survival was 56.3% after CyberKinfe (R) radiotherapy. The best survival rate (96.8% at 1 year) was for patients with brain tumors. In patient's characteristics, A better Eastern Cooperative Oncology Group (ECOG) performance status, treatment for primary tumors, and outpatient treatment were independent factors for superior survival after CyberKnife (R) radiotherapy. The survivals for patients whose treatment expenses were approved for reimbursement after prereview by NHI were also better than out-of-pocket. Conclusions: Besides the patients' characteristics, the treatment expense could be approved or rejected for reimbursement by the NHI prereview was an independent factor for survival in CyberKnife (R) radiotherapy. Prereview to reimburse expensive treatment is not an unreasonable requirement.