Costs, evidence, and value in the Medicare program: the challenges of technology innovation in breast cancer prevention and control.
Costs, evidence, and value in the Medicare program: the challenges of technology innovation in breast cancer prevention and control.
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DOI：
10.1001/jamainternmed.2013.2127
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发表时间：
2013-02-11
影响因子：
39
通讯作者：
van Ravesteyn, Nicolien T.
中科院分区：
文献类型：
--
作者：
Mandelblatt, Jeanne S.;Tosteson, Anna N. A.;van Ravesteyn, Nicolien T.
根据美国的寿命表，现在65岁的女性有望再活20年，而那些75岁的女性平均还会再活13年。1965年颁布的联邦医疗保险计划，目前为大约3000万65岁或以上的美国女性(以下称为“老年人”)提供护理，由于“美国老龄化”，预计到2030年，这一数字将翻一番。2010年，医疗保险总支出为5230亿美元，其中乳腺癌筛查约占10亿美元。Gross等人在本期发表的一篇具有挑衅性的文章调查了对新的、更昂贵的乳腺癌筛查技术的投资，如数字乳房X光照相，是否为美国日益增长的老年女性人口的护理提供了良好的投资回报。数字乳房X光检查有效性的证据来自美国放射成像网络数字乳房X光成像筛查试验；该试验于2005年发表，涉及超过4万名各个年龄段的女性。这些结果发表后，数字筛查在美国迅速推广到实践中。尽管初步试验发现，数字乳房X光检查和普通胶片乳房X光检查在检测乳腺癌方面没有总体差异，但这种情况还是发生了，尽管它对年龄在50岁以下、乳房致密的绝经前或围绝经期女性更好。值得注意的是，在65岁或以上的女性中，她们的乳房脂肪比例高于致密的乳房组织，实际上有一种强烈的趋势是，数字乳房X光检查的表现不如普通胶片乳房X光检查。2然而，联邦医疗保险在其年度乳腺癌筛查福利中涵盖了这项服务，并将继续这样做，尽管老年妇女受益的证据有限，而且缺乏成本效益。3.
Women who are now 65 years old can expect to live another 20 years, and those aged 75 years will live, on average, for another 13 years based on US life tables. The Medicare program, enacted in 1965, currently provides care to approximately 30 million US women 65 years or older (hereinafter referred to as “older”), and that number is projected to double by 2030 owing to the “graying of America.” Total Medicare spending was $523 billion in 2010 with breast cancer screening accounting for about $1 billion of that total.The provocative article by Gross et al1 published in this issue examines whether investments in new and more expensive breast cancer screening technologies, such as digital mammography, provide a good return on investment in the care of the growing older US female population. Evidence on the efficacy of digital mammography comes from the American College of Radiology Imaging Network Digital Mammographic Imaging Screening Trial; published in 2005, the trial involved more than 40 000 women of all ages. Digital screening rapidly disseminated into practice in the United States after these results were published. This occurred despite the primary trial finding that there was no overall difference between digital and plain-film mammography in detecting breast cancer, although it was superior for premenopausal or perimenopausal women younger than 50 years with dense breasts. Notably, among women 65 or older, whose breasts have a higher proportion of fat than dense mammary tissue, there was actually a strong trend for digital mammography to perform worse than plain film mammography. 2 Yet Medicare has covered this service under its annual breast cancer screening benefit and continues to do so, despite limitations in evidence of benefit for older women and lack of cost-effectiveness. 3
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影响因子：
19.7
作者：
Pisano, Etta D.;Hendrick, R. Edward;Gatsonis, Constantine A.
通讯作者：
Gatsonis, Constantine A.
影响因子：
39.2
作者：
Calonge, Ned;Petitti, Diana B.;Wilt, Timothy
通讯作者：
Wilt, Timothy
影响因子：
39.2
作者：
Tosteson, Anna N. A.;Stout, Natasha K.;Pisano, Etta D.
通讯作者：
Pisano, Etta D.
影响因子：
10.3
作者：
Goldie, Sue J.;Daniels, Norman
通讯作者：
Daniels, Norman
影响因子：
39
作者：
Gross, Cary P.;Long, Jessica B.;Ma, Xiaomei
通讯作者：
Ma, Xiaomei