Reimbursements and frequency of tests in privately insured testicular cancer patients in the United States: Implications to national guidelines

The objective of this study was to assess the frequency of utilization and reimbursement of the common diagnostic tests and treatment modalities used in testicular cancer care. LifeLink™ (IMS Health, Danbury, CT, USA) Claims Database was used. We identified 877 subjects with a primary diagnosis of testicular cancer (ICD 186.9) between 2007 and 2012. Median reimbursement and frequency of the diagnostic/treatment modalities used were recorded. The most common claim was a vein puncture with median reimbursement of $9.11. Tumor markers, alpha-fetoprotein and beta human chorionic gonadotropin, were ranked 6 and 7 with median reimbursement of $52.13 and $48.71, respectively. Chest X-ray and computerized tomography (CT) scan of the chest were ranked 9 and 13 with median reimbursement of $68.51 and $769, respectively. A contrast CT scan of abdomen and pelvis was the 11 most frequent claim with median reimbursement of $855.89. The three invasive treatment modalities, chemotherapy, radiation therapy, and retroperitoneal lymphadenectomy were ranked 8 , 15 , and 164 with median reimbursement of $2858.38, $3988.25, and $2009.67, respectively. Testicular cancer is not an inexpensive disease. Surgery is the less utilized than radiation and chemotherapy despite lower cost. This may have implications to national guidelines and training since these treatments often carry the same grade of recommendation.