Article

Estimating personal costs incurred by a woman participating in mammography screening in the National Breast and Cervical Cancer Early Detection Program

Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
Cancer (Impact Factor: 4.9). 08/2008; 113(3):592-601. DOI: 10.1002/cncr.23613
Source: PubMed

ABSTRACT The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) covers the direct clinical costs of breast and cervical cancer screening and diagnostic follow-up for medically underserved, low-income women. Personal costs are not covered. In this report, the authors estimated personal costs per woman participating in NBCCEDP mammography screening by race/ethnicity and also estimated lifetime personal costs (ages 50-74 years).
A decision analysis model was constructed and parameterized by using empiric data from a retrospective cohort survey of mammography rescreening among women ages 50 years to 64 years who participated in the NBCCEDP. Data from 1870 women were collected from 1999 to 2000. The model simulated the flow of resources incurred by a woman participating in the NBCCEDP. The analysis was stratified by annual income into 2 scenarios: Scenario 1, <$10,000; and Scenario 2, from $10,000 to <$20,000. Sensitivity analyses were conducted to appraise uncertainty, and all costs were standardized to 2000 U.S. dollars.
In Scenario 1, for all races/ethnicities, a woman incurred a 1-time cost of $17 and a discounted lifetime cost of $108 for 10 screens and $262 for 25 screens; in Scenario 2, these amounts were $31 and from $197 to $475, respectively. In both scenarios, a non-Hispanic white woman incurred the highest cost. The sensitivity analyses revealed that >70% of cost incurred was attributable to opportunity cost.
Capturing and quantifying personal costs will help ascertain the total cost (ie, societal cost) of providing mammography screening to a medically underserved, low-income woman participating in a publicly funded cancer screening program and, thus, will help determine the true cost-effectiveness of such programs.

Download full-text

Full-text

Available from: Donatus (Don) U Ekwueme, Oct 16, 2014
0 Followers
 · 
72 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We prospectively evaluated procedural costs and resource consumption patterns in the EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) study after coronary calcium (CAC) measurements. Controversy surrounds expansion of cardiovascular disease (CVD) screening to include atherosclerosis imaging as the result of concern whether induced costs will outweigh any benefit. Detailed risk factor and CAC measurements with 4-year follow-up for CVD death or myocardial infarction and procedures were performed. Costs were estimated with the use of Medicare reimbursement rates (discounted and inflation corrected). Cox survival analysis was used to estimate procedures and events. CAC scores varied widely but were skewed toward low scores with 56.7% of screened subjects having CAC scores<or=10 and only 8.2% having CAC scores>or=400. Noninvasive testing was infrequent and medical costs were low among subjects with low CAC scores, both rising progressively with increasing CAC scores (p<0.001), particularly in the 31 (2.2% of subjects) that had CAC scores>or=1,000. Similarly, invasive coronary angiography rose progressively with increasing scores (p<0.001) but occurred exclusively among subjects first undergoing noninvasive testing and overall, was performed in only 19.4% of subjects with CAC scores>or=1,000. CAC scanning is associated with a marked differential in downstream frequency of medical tests and costs, ranging from a very low frequency of testing and invasive procedures among a predominantly large percentage of subjects with low CAC scores, to selectively concentrated testing and procedures among a small number of subjects with CAC scores>400. Thus, CAC scanning appears to foster efficient selective testing patterns among asymptomatic individuals at risk for CVD.
    Journal of the American College of Cardiology 09/2009; 54(14):1258-67. DOI:10.1016/j.jacc.2009.07.018 · 15.34 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to explore women's interest and preferences in undergoing screening mammography in a retail health care setting. Self-administered surveys were distributed to 400 mammography patients in May to June 2009. All of the women who were asked were eligible for screening (age >40 years, no abnormal mammographic findings in the recent past). Three hundred eighty-six screening-eligible women filled out and returned the self-administered survey. The average respondent age was 57 years. Three hundred ten of the patients (80.3%) had college or postgraduate educations. Two hundred three (52.6%) reported annual incomes >$60,000. Two hundred forty-one respondents (62.4%) had been undergoing screening mammography for >10 years, while this was the first examination for eight patients (2%). More than half of the patients (n = 215 [55.7%]) affirmed their interest in undergoing annual screening mammography in a private area within a retail shopping facility. Most preferred a pharmacy (77%) over Wal-Mart or a grocery store. Appealing factors about a retail setting were proximity to home (90%), free parking (62%), and operating hours (48.8%). There is interest among women in undergoing screening mammography at retail health care clinics, preferably pharmacies. The provision of services at a convenient location can increase adherence to guidelines for screening mammography.
    Academic radiology 10/2012; 19(10):1268-72. DOI:10.1016/j.acra.2012.04.022 · 2.08 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Endoscopic surveillance has been proven effective in prolonging the survival of gastric cancer (GC) patients. However, there is limited evidence on the cost efficiency of delivering this intervention, especially on a national level in spite of cost efficiency being a major determinant of the actual cost-effectiveness of a cancer prevention programme. The Singapore Gastric Cancer Epidemiology Clinical and Genetic Programme (GCEP) is a demonstration project offering scheduled endoscopy to the Chinese population aged 50 years or older in Singapore. By assessing the cost efficiency of the GCEP, this study aimed to provide empirical evidence on the cost structure and mechanisms underlying cost generation in conducting GC surveillance, thus informing resource allocation and programme budgeting for the Singapore government. Methods From a societal perspective, we reported on the direct cost (resource consumption) of conducting endoscopic surveillance through the GCEP network. We retrospectively collected individual-level data of 216 subjects recruited at the National University Hospital, Singapore from 01/04/2004 to 31/10/2010. The Overall Cost, Clinical Cost, GCEP Cost and Personal Cost incurred in serving one subject was computed and discounted as 2004 US dollar (US$) per capita for every year. The Generalized Estimation Equation (GEE) was used to model the data. Results All cost indices continuously declined over the 6.5-year costing period. For the total sample, Overall Cost, Clinical Cost, GCEP Cost and Personal Cost declined by 42.3%, 54.1%, 30% and 25.7% respectively. This downward trend existed for age and gender subgroups and the high risk group only with cost reductions varying between 3.5% and 58.4%. The GEE models confirmed statistical significance of the downward trend and of its association with risk profile, where the moderate risk group had cost indices at most 77% of the high risk group. Conclusions Our study offered empirical evidence of improved cost efficiency of a surveillance programme for GC in the early phase of programme implementation. Mechanisms such as economies of scale and self-learning were found to be involved in the cost reduction. Our findings highlighted the importance of assessing the cost efficiency and offered valuable insights for future programme budgeting and policy making.
    BMC Health Services Research 04/2013; 13(1):139. DOI:10.1186/1472-6963-13-139 · 1.66 Impact Factor