Vlahiotis Anna, Griffin Brian, Stavros A Thomas, Margolis Jay
Value Based Care, Outcomes Research, Truven Health Analytics, an IBM Company, Bethesda, MD USA.
Value Based Care, Outcomes Research, Truven Health Analytics, an IBM Company, Newark, NJ, USA.
Clinicoecon Outcomes Res. 2018 Mar 26;10:157-167. doi: 10.2147/CEOR.S150260. eCollection 2018.
Little data exist on real-world patterns and associated costs of downstream breast diagnostic procedures following an abnormal screening mammography or clinical exam.
To analyze the utilization patterns in real-world clinical settings for breast imaging and diagnostic procedures, including the frequency and volume of patients and procedures, procedure sequencing, and associated health care expenditures.
Using medical claims from 2011 to 2015 MarketScan Commercial and Medicare Databases, adult females with breast imaging/diagnostic procedures (diagnostic mammography, ultrasound, molecular breast imaging, tomosynthesis, magnetic resonance imaging, or biopsy) other than screening mammography were selected. Continuous health plan coverage without breast diagnostic procedures was required for ≥13 months before the first found breast diagnostic procedure (index event), with a 13-month post-index follow-up period. Key outcomes included diagnostic procedure volumes, sequences, and payments. Results reported descriptively were projected to provide US national patient and procedure volumes.
The final sample of 875,526 patients was nationally projected to 12,394,432 patients annually receiving 8,732,909 diagnostic mammograms (53.3% of patients), 6,987,399 breast ultrasounds (42.4% of patients), and 1,585,856 biopsies (10.3% of patients). Following initial diagnostic procedures, 49.4% had second procedures, 20.1% followed with third procedures, and 10.0% had a fourth procedure. Mean (SD) costs for diagnostic mammograms of US$349 ($493), ultrasounds US$132 ($134), and biopsies US$1,938 ($2,343) contributed US$3.05 billion, US$0.92 billion, and US$3.07 billion, respectively, to annual diagnostic breast expenditures estimated at US$7.91 billion.
The volume and expense of additional breast diagnostic testing, estimated at US$7.91 billion annually, underscores the need for technological improvements in the breast diagnostic landscape.
关于乳腺钼靶筛查异常或临床检查后下游乳腺诊断程序的真实世界模式及相关成本的数据很少。
分析乳腺成像和诊断程序在真实临床环境中的使用模式，包括患者和程序的频率及数量、程序顺序以及相关医疗保健支出。
使用2011年至2015年MarketScan商业和医疗保险数据库中的医疗理赔数据，选取接受过除乳腺钼靶筛查之外的乳腺成像/诊断程序（诊断性乳腺钼靶、超声、分子乳腺成像、断层合成、磁共振成像或活检）的成年女性。在首次发现乳腺诊断程序（索引事件）前需要连续13个月以上无乳腺诊断程序的健康计划覆盖，并在索引事件后有13个月的随访期。主要结果包括诊断程序数量、顺序和费用。以描述性方式报告的结果经推算以提供美国全国患者和程序数量。
最终样本中的875,526名患者经全国推算为每年有12,394,432名患者接受8,732,909次诊断性乳腺钼靶检查（占患者的53.3%）、6,987,399次乳腺超声检查（占患者的42.4%）和1,585,856次活检（占患者的10.3%）。在首次诊断程序之后，49.4%的患者进行了第二次程序，20.1%的患者进行了第三次程序，10.0%的患者进行了第四次程序。诊断性乳腺钼靶检查的平均（标准差）成本为349美元（493美元），超声检查为132美元（134美元），活检为1,938美元（2,343美元），分别为估计每年79.1亿美元的乳腺诊断支出贡献了30.5亿美元、9.2亿美元和30.7亿美元。
每年估计为79.1亿美元的额外乳腺诊断检测的数量和费用凸显了乳腺诊断领域技术改进的必要性。
