Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia.
Department of Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, Virginia.
Cancer Prev Res (Phila). 2023 Jul 5;16(7):385-391. doi: 10.1158/1940-6207.CAPR-22-0531.
Timely follow-up care after an abnormal cervical cancer screening test result is critical to the prevention and early diagnosis of cervical cancer. The current inadequate and inequitable delivery of these potentially life-saving services is attributed to several factors, including patient out-of-pocket costs. Waiving of consumer cost-sharing for follow-up testing (e.g., colposcopy and related cervical services) is likely to improve access and uptake, especially among underserved populations. One approach to defray the incremental costs of providing more generous coverage for follow-up testing is reducing expenditures on "low-value" cervical cancer screening services. To explore the potential fiscal implications of a policy that redirects cervical cancer screening resources from potentially low- to high-value clinical scenarios, we analyzed 2019 claims from the Virginia All-Payer Claims Database to quantify (i) total spending on low-value cervical cancer screening and (ii) out-of-pocket costs associated with colposcopy and related cervical services among commercially insured Virginians. In a cohort of 1,806,921 female patients (ages 48.1 ± 24.8 years), 295,193 claims for cervical cancer screening were reported, 100,567 (34.0%) of which were determined to be low-value ($4,394,361 total; $4,172,777 for payers and $221,584 out-of-pocket [$2/patient]). Claims for 52,369 colposcopy and related cervical services were reported ($40,994,016 total; $33,457,518 for payers and $7,536,498 out-of-pocket [$144/patient]). These findings suggest that reallocating savings incurred from unnecessary spending to fund more generous coverage of necessary follow-up care is a feasible approach to enhancing cervical cancer prevention equity and outcomes.
Out-of-pocket fees are a barrier to follow-up care after an abnormal cervical cancer screening test. Among commercially insured Virginians, out-of-pocket costs for follow-up services averaged $144/patient; 34% of cervical cancer screenings were classified as low value. Reallocating low-value cervical cancer screening expenditures to enhance coverage for follow-up care can improve screening outcomes. See related Spotlight, p. 363.
目的：及时跟进宫颈癌筛查异常的后续护理对于预防和早期发现宫颈癌至关重要。当前，由于多种因素，包括患者自付费用，这些具有潜在挽救生命的服务的提供不足且不公平。免除后续检测（如阴道镜检查和相关宫颈服务）的消费者自付费用可能会增加服务的可及性和利用率，尤其是在服务不足的人群中。为了减轻提供更慷慨的后续检测服务的增量成本，一种方法是减少对“低价值”宫颈癌筛查服务的支出。为了探索将宫颈癌筛查资源从潜在低价值临床场景重新分配到高价值临床场景的政策的潜在财政影响，我们分析了弗吉尼亚州所有支付者索赔数据库中的 2019 年索赔数据，以量化（i）低价值宫颈癌筛查的总支出，以及（ii）商业投保的弗吉尼亚州女性中与阴道镜检查和相关宫颈服务相关的自付费用。在一个有 1806921 名女性患者（年龄 48.1 ± 24.8 岁）的队列中，报告了 295193 例宫颈癌筛查索赔，其中 100567 例（34.0%）被确定为低价值（总费用为 4394361 美元；33457518 美元由支付方承担，221584 美元由患者自付[每位患者 2 美元]）。报告了 52369 例阴道镜检查和相关宫颈服务的索赔（总费用为 40994016 美元；33457518 美元由支付方承担，7536498 美元由患者自付[每位患者 144 美元]）。这些发现表明，将不必要支出节省的资金重新分配用于为必要的后续护理提供更慷慨的覆盖范围，是提高宫颈癌预防公平性和结果的可行方法。
预防相关性：自付费用是宫颈癌筛查异常后进行后续护理的障碍。在商业投保的弗吉尼亚州人中，后续护理服务的自付费用平均为每位患者 144 美元；34%的宫颈癌筛查被归类为低价值。重新分配低价值宫颈癌筛查支出以增强后续护理的覆盖范围可以改善筛查结果。参见相关焦点文章，第 363 页。
