Outside Threats to the Image-Guided Bone Pain Relief Market

Radiology dominates the rapidly increasing market for image-guided ablation for bone pain, most often caused by cancer that has metastasized to the bones. Upwards of 80% of metastatic breast, lung, and prostate cancers develop osseous metastases as the patient’s cancer spreads to the bones. Over three-quarters of these patients develop pain.

Mona Ranade, MD, an interventional radiologist with UCLA Health and co-authors with Mount Sinai Hospital in New York, examined claims for ablation from 2015-to-2018. Claims rose significantly — rising more than 45% average year-over-year among Medicare recipients.

However, all of this growth is tempered by a decline in market share for radiologists. Their share of this expanding market dropped from just under 81% to 73%, while neurosurgeons’ share grew from 5% to over 11%.

Study investigators researched annual volumes for the two billable codes — 1) radiofrequency ablation using electricity to heat the nerve tissue to stop pain signals, and 2) cryoablation using extremely cold liquid. They used Medicare claims submitted by physicians and related facilities/providers.

• Radiofrequency ablation grew exponentially, rising 252% during the 4-year study period.
• Cryoablation rose 144%.

However, radiology only accounted for a 76% market share. The other quarter of the market was shared by:

• Neurosurgery – 9%
• Orthopedics – 7%
• Pain management – 6%

It should be noted that pain management doubled its share from 3% to 6% over the study period.

Site of service helps discern the where for pain management’s increase in market share. Outpatient hospitals comprise the majority of patient encounters — 63% for outpatients and 30% for inpatients. Both sites experienced similar increases in patients, but there is a dramatic difference in who benefited based on site location.

• Outpatient facilities – radiologists’ growth increased from 53% to 65% of the market.
• Inpatient locales – pain management soared from 13% to almost 48%.

The investigators suggest that radiologists not view this data as suggestive of stagnation or fewer procedures performed by radiologists. Radiofrequency ablation has grown dramatically in recent years.

Radiologists still perform almost three-quarters of image-guided bone pain management. Rather, radiologists must look at outside sources to understand the loss of market share. Ranade and her co-authors suggest several possible explanations for the shift.

1. Osseous ablation doesn’t require a large financial investment in equipment.
2. Many procedures can be accomplished with a C-arm, allowing neurosurgeons and pain management specialists to gain the necessary skills rather quickly.
3. Treatment of osseous metastases is a natural extension of the growing pain medicine field.
4. Referral patterns from primary care physicians and oncologists could contribute to the decline in market share.