(ChemotherapyAdvisor) – Driven by newer and more expensive technologies, cost of screening for breast cancer among fee-for-service Medicare enrollees exceeded $1 billion annually, with substantial regional variation and no clear indication that better outcomes are achieved, a study concluded in JAMA Internal Medicine, a JAMA Network publication, published online January 7, 2013.
Cary P. Gross, MD, of the Yale University School of Medicine, New Haven, CT, and colleagues used the linked Surveillance Epidemiology and End Results (SEER)-Medicare database to identify 137,274 women between the ages of 66 and 100 who had not had breast cancer and to assess the cost to Medicare of breast cancer screening and workup performed between 2006 and 2007. Initial treatment costs for women who developed cancer was calculated. Screening-related costs were assessed at the Hospital Referral Region (HRR) level and the association between regional expenditures and workup test utilization, cancer incidence, and treatment costs evaluated.
They found that breast cancer screening and work-up costs were $1.08 billion and treatment expenditures, $1.36 billion.
“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% 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 authors noted.
Costs exceeded $410 million among women 75 years or older, with age standardized screening-related cost per beneficiary varying from $42 to $107 per beneficiary across HRRs. In the highest and lowest quartiles of cost, digital screening mammography and computer-aided detection accounted for 65% of the difference in screening-related cost between regions. Women living in regions 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]).
No significant difference was found in the cost of initial cancer treatment per beneficiary between the highest and lowest screening cost HRRs, $151 vs. $115 (P=0.20).
“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,” they concluded. “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.”
In an invited commentary, Jeanne S. Mandelblatt, MD, MPH, of Georgetown University, Washington, and colleagues wrote, “for all of these conditions, interventions, and decisions about Medicare coverage, the real question raised by the research of Gross et al that must be answered is how we put a value on the life of any person or group.”