575 - State-Level Trends and Disparities in Transarterial Radioembolization Utilization by Medicare Part B Beneficiaries from 2013-2023

Purpose: This study aimed to examine state-level disparities in transarterial radioembolization (TARE) utilization among Medicare Part B beneficiaries in the United States from 2013 to 2023.

Materials and Methods: The CMS “Medicare Physician & Other Practitioners - by Provider” dataset (2013-2023) was queried {1}.TARE procedures were identified using the CPT code 79445 and total number of distinct services were recorded (facility and non-facility combined). Counts were standardized as services per 1,000,000 residents aged ≥65 years using population data from the Annie E. Casey Foundation {2}. Annual and median values across years were calculated, and state-level trends were visualized to identify top and bottom utilizers.

Results: By median gross number of distinct services, the highest-utilization states were California (396.0), Florida (322.5), Illinois (267.0), Texas (226.0), and New York (212.5), while the lowest were Iowa (13.5), Vermont (14.0), Montana (15.0), Rhode Island (15.0), and New Hampshire (16.5). When adjusted per 1,000,000 residents aged 65 or older, the highest medians were observed in the District of Columbia (362.62), South Dakota (132.43), Washington (128.13), Illinois (127.63), and Delaware (122.51). The lowest were Iowa (24.11), Connecticut (30.03), Kentucky (34.28), Minnesota (48.32), and New Jersey (49.36). Across states, adjusted service rates generally ranged from 11.39–255.62, except for the District of Columbia, which consistently demonstrated outlier values (range: 166.85–668.60) and the highest utilization throughout the study period. Utilization rates increased steadily across most states until 2020, except Iowa, where rates remained largely unchanged.

Conclusion: State-level analysis revealed substantial disparities in TARE utilization among Medicare Part B beneficiaries. Most states showed rising rates through 2020, while Iowa remained stable. The District of Columbia consistently exhibited the highest standardized rates. These findings highlight geographic heterogeneity in TARE access and use, likely reflecting differences in cancer epidemiology, provider availability, or referral patterns, warranting further investigation.