A brachy bonus.

We’ve known for decades that brachytherapy is a key component of curing locally-advanced cervical cancer. So why do rates of its (appropriate) use continue to precipitously fall? Last month’s Red Journal pub offers a simple answer wrapped in a timeless idiom: Show me the money. Authors from the University of Virginia (UVA) performed a cost-effectiveness analysis at their institution of each component of the treatment process for the administration of definitive chemoradiation from start to finish. Personnel resources were 3.5x more for the brachy portion than for the sum of simulation and external beam radiation combined. This equates to physicians spending about 5.7 minutes per relative value unit (RVU) with brachy versus 1.3 to 1.6 minutes per RVU with intensity-modulated or whole pelvis radiation, respectively. It’s already recognized that bigger centers deliver higher rates of brachy, which may be related to bigger abilities to absorb costs. Bottomline: this life-saving but resource-draining procedure is long overdue for a raise.