Document Detail


The cost of breast cancer screening in the Medicare population.
MedLine Citation:
PMID:  23303200     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Little is known about the cost to Medicare of breast cancer screening or whether regional-level screening expenditures are associated with cancer stage at diagnosis or treatment costs, particularly because newer breast cancer screening technologies, like digital mammography and computer-aided detection (CAD), have diffused into the care of older women.
METHODS: Using the linked Surveillance, Epidemiology, and End Results-Medicare database, we identified 137 274 women ages 66 to 100 years who had not had breast cancer and assessed the cost to fee-for-service Medicare of breast cancer screening and workup during 2006 to 2007. For women who developed cancer, we calculated initial treatment cost. We then assessed screening-related cost at the Hospital Referral Region (HRR) level and evaluated the association between regional expenditures and workup test utilization, cancer incidence, and treatment costs.
RESULTS: In the United States, the annual costs to fee-for-service Medicare for breast cancer screening-related procedures (comprising screening plus workup) and treatment expenditures were $1.08 billion and $1.36 billion, respectively. For women 75 years or older, annual screening-related expenditures exceeded $410 million. Age-standardized screening-related cost per beneficiary varied more than 2-fold across regions (from $42 to $107 per beneficiary); digital screening mammography and CAD accounted for 65% of the difference in screening-related cost between HRRs in the highest and lowest quartiles of cost. Women residing in HRRs with high screening costs were more likely to be diagnosed as having early-stage cancer (incidence rate ratio, 1.78 [95% CI, 1.40-2.26]). There was no significant difference in the cost of initial cancer treatment per beneficiary between the highest and lowest screening cost HRRs ($151 vs $115; P = .20).
CONCLUSIONS: The cost to Medicare of breast cancer screening exceeds $1 billion annually in the fee-for-service program. Regional variation is substantial and driven by the use of newer and more expensive technologies; it is unclear whether higher screening expenditures are achieving better breast cancer outcomes.
Authors:
Cary P Gross; Jessica B Long; Joseph S Ross; Maysa M Abu-Khalaf; Rong Wang; Brigid K Killelea; Heather T Gold; Anees B Chagpar; Xiaomei Ma
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  JAMA internal medicine     Volume:  173     ISSN:  2168-6114     ISO Abbreviation:  JAMA Intern Med     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-12     Completed Date:  2013-04-08     Revised Date:  2014-02-13    
Medline Journal Info:
Nlm Unique ID:  101589534     Medline TA:  JAMA Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  220-6     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Breast Neoplasms / diagnosis*,  economics,  epidemiology,  therapy
Fee-for-Service Plans / economics
Female
Humans
Incidence
Mass Screening / economics*
Medicare / economics*
United States / epidemiology
Grant Support
ID/Acronym/Agency:
5R01CA149045/CA/NCI NIH HHS; K08 AG032886/AG/NIA NIH HHS; K08 AG032886/AG/NIA NIH HHS; N01-PC-35136/PC/NCI NIH HHS; N01-PC-35139/PC/NCI NIH HHS; N02-PC-15105/PC/NCI NIH HHS; R01 CA149045/CA/NCI NIH HHS; U55/CCR921930-02//PHS HHS
Comments/Corrections
Comment In:
JAMA Intern Med. 2013 Feb 11;173(3):227-8   [PMID:  23303388 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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