Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Oslo, Norway.
Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine and Yale Cancer Center.
Med Care. 2021 May 1;59(5):437-443. doi: 10.1097/MLR.0000000000001506.
Breast cancer screening for women aged 40-49 years is prevalent and costly, with costs varying substantially across US regions. Newer approaches to mammography may improve cancer detection but also increase screening costs. We assessed factors associated with regional variation in screening costs.
We used Blue Cross Blue Shield Axis, a large US commercial claims database accessed through secure portal, to assess regional variation in screening utilization and costs. We included screening mammography±digital breast tomosynthesis (DBT), screening ultrasound, diagnostic mammography±DBT, diagnostic ultrasound, magnetic resonance imaging and biopsy, and evaluated their utilization and costs. We assessed regional variation in annual per-screened-beneficiary costs and examined potential savings from reducing regional variation.
Of the 2,257,393 privately insured women, 41.2% received screening mammography in 2017 (range: 26.6%-54.2% across regions). Wide regional variation was found in the DBT proportion (0.7%-91.1%) and mean costs of DBT ($299; range: $113-714) and 2-dimensional (D) mammograms ($213; range: $107-471). In one-fourth of the regions, the mean DBT cost was lower than the mean 2D mammography cost in the full sample. Regional variation in the per-screened-beneficiary cost (mean: $353; range: $151-751) was mainly attributable to variation in the cost of DBT (accounting for 23.4% of regional variation) and 2D mammography (23.0%). Reducing regional variation by decreasing the highest values to the national mean was projected to save $79-335 million annually.
The mean mammogram cost for privately insured women ages 40-49 varies 7-fold across regions, driving substantial variation in breast cancer screening costs. Reducing this regional variation would substantially decrease the screening costs.
40-49 岁女性的乳腺癌筛查较为普遍且费用高昂，美国各地区之间的费用差异很大。新型乳房 X 光摄影技术可能提高癌症检出率，但也会增加筛查成本。我们评估了导致筛查成本区域差异的因素。
我们使用了 Blue Cross Blue Shield Axis，这是一个通过安全门户访问的大型美国商业索赔数据库，以评估筛查利用和成本的区域差异。我们纳入了筛查性乳房 X 光摄影术±数字乳腺断层合成术（DBT）、筛查性超声、诊断性乳房 X 光摄影术±DBT、诊断性超声、磁共振成像和活检，并评估了它们的利用和成本。我们评估了每位受筛查受益人的年度筛查成本的区域差异，并研究了降低区域差异的潜在节省。
在 2257393 名私人保险女性中，41.2%（2017 年各地区比例为 26.6%-54.2%）接受了筛查性乳房 X 光摄影术。DBT 比例（0.7%-91.1%）和 DBT 平均费用（$299；范围：$113-714）以及二维（D）乳房 X 光摄影术平均费用（$213；范围：$107-471）在各地区之间存在广泛的差异。在四分之一的地区，DBT 的平均成本低于全样本中二维乳房 X 光摄影术的平均成本。每位受筛查受益人的成本（$353；范围：$151-751）的区域差异主要归因于 DBT 成本的差异（占区域差异的 23.4%）和二维乳房 X 光摄影术（23.0%）。预计将最高值降低到全国平均水平，每年可节省 7900 万至 3.35 亿美元。
40-49 岁私人保险女性的平均乳房 X 光摄影术费用在各地区之间相差 7 倍，导致乳腺癌筛查成本存在巨大差异。减少这种区域差异将大大降低筛查成本。
