The Cost of Breast Cancer Screening in the Medicare Population
The Cost of Breast Cancer Screening in the Medicare Population
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DOI：
10.1001/jamainternmed.2013.1397
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发表时间：
2013-02-11
影响因子：
39
通讯作者：
Ma, Xiaomei
中科院分区：
文献类型：
--
作者：
Gross, Cary P.;Long, Jessica B.;Ma, Xiaomei
背景：关于乳腺癌筛查的医疗保险费用，以及地区层面的筛查支出是否与癌症分期诊断或治疗费用相关，人们知之甚少，特别是因为较新的乳腺癌筛查技术，如数字乳房X光摄影和计算机辅助检测(CAD)，已经渗透到老年妇女的护理中。方法：使用链接的监测、流行病学和最终结果-联邦医疗保险数据库，我们确定了137 274名年龄在66岁到100岁之间的未患乳腺癌的女性，并评估了2006至2007年间乳腺癌筛查和体检的按服务收费的联邦医疗保险的成本。对于罹患癌症的女性，我们计算了最初的治疗费用。然后，我们评估了医院转诊区域(HRR)水平的筛查相关成本，并评估了地区支出与体检使用、癌症发病率和治疗成本之间的关系。结果：在美国，乳腺癌筛查相关程序(包括筛查和体检)的按服务收费医疗保险的年成本和治疗支出分别为10.8亿美元和13.6亿美元。对于75岁或以上的女性，每年与筛查相关的支出超过4.1亿美元。各地区每个受益人的年龄标准化筛查相关成本相差2倍以上(每个受益人从42美元到107美元不等)；数字筛查、乳房X光检查和CAD占成本最高和最低四分之一的HRR之间筛查相关成本差异的65%。居住在筛查费用高的HRR中的妇女更有可能被诊断为早期癌症(发病率比，1.78[95%CI，1.40-2.26])。在最高和最低筛查费用HRR之间，每个受益人的初始癌症治疗费用没有显著差异(151美元对115美元；P=.20)。结论：在按服务收费的计划中，乳腺癌筛查的医疗保险费用每年超过10亿美元。地区差异很大，而且是由更新、更昂贵的技术的使用推动的；目前尚不清楚更高的筛查支出是否会带来更好的乳腺癌结果。《美国医学会实习生杂志》2013；173(3)：220-226。2013年1月7日在线发布。DOI：10.1001/jamaintermed.2013.1397
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. JAMA Intern Med.2013;173(3): 220-226. Published online January 7, 2013. doi:10.1001/jamainternmed.2013.1397