Screening expenses for breast cancer in the Medicare program reached over $1 billion per year in the fee-for-service program during 2006 to 2007 with significant variations by regions due to new and more costly technologies. It has not yet been established that these expensive technologies can create improved breast cancer outcomes.
New technologies for breast cancer screening, like computer-aided detection (CAD) and digital mammography, have greatly strengthened choices at hand for health professionals, however these new methods can be costly.
Costs may be directly raised through reimbursement for the tests as well as causing higher rates of biopsy or cancer detection and supplemental imaging.
Examining the link between population results and screening costs is crucial, because although new technology may make it easier to detect cancer, it may not improve outcomes. The authors suggest this is apparent especially in older women.
A group of researchers led by Cary P. Gross, M.D., of the Yale University School of Medicine, New Haven, Connecticut, looked at data from the linked Surveillance, Epidemiology, and End Results-Medicare database to pinpoint 137,274 women who had not had breast cancer. The women were aged 66 to 100 years and were evaluated for the expenses to fee-for-service Medicare breast cancer screening and workup they received during 2006 to 2007.
The investigators also looked at screening-related costs at the Hospital Referral Region (HRR) level and examined the link between using workup tests, cancer incidence, treatment results, and regional spending.
The authors explained:
"We found that the Medicare fee-for-service program is spending over $1 billion per year on breast cancer screening and workup of suspicious lesions. This accounted for over 45 percent of the $2.42 billion total spent by Medicare on screening and the initial treatment phase of breast cancer, suggesting that analyses that focus exclusively on treatment have overlooked a significant contributor to cancer costs."
The study also found that for women over the age of 75, yearly screening-related costs soared over $410 million. Among different regions, costs varied more than two-fold for age-regulated, screening-related expenses per recipient (from $42 to $107 per person). Also, CAD and digital screening mammography made up for 65 percent of the variation in screening-related expenses between HRRs.
Women who live in HHRs with expensive screening costs were more inclined to be diagnosed early (incidence rate ratio of 1.78). The results also showed there was no noteworthy variation seen in the cost of first cancer treatment per person between the highest and lowest screening expense HRRs ($151 vs. $115).
The authors conclude:
"In summary, the costs of breast cancer care in the Medicare population, when incorporating screening costs, are substantially higher than previously documented and the adoption of newer screening modalities will likely contribute to further growth. The growth trajectory may be steeper than projected owing to Medicare's reimbursement strategy, which supports rapid adoption of newer modalities, frequently without adequate data to support their use."
Written by Kelly Fitzgerald